P - 84746:��f-013
REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Indusfrial Farm
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above. fhe work covered by this request. Enter remarks in this space and on the back of tF
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Calcvlate Inspecfion Fee - This Inspection Request will noi be accepfed without the correcf fee:
Other fee # Service Entrance Size Fee # Circuits
Mobile Home Pork Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
$ign/Oudine Ltg. Xfmr. 5. �C
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the elechical insfallafion described herein on fhe dafes sfafed
Irrigation Boom Rou9�^ Dare
Remod
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copy only.
THIS INSTALLATION MAY BE ORDERED DISC
Fee
%c --�_ -- I�'/S �/
IF NOT CQMPLETED WITHIN 18 MONTHS.
OFFICE U� ONLY This request void 18 months from validation date printed in this box.
I��Ill�illl�lll�l�l������ II�I�����I�II����II��) %�s� �`���v � �
* � 4 9 6 � L 3 4* PLEASE PRINT OR TYPE
R�� �°� Rough-in inspeclion required2 ❑ Yes o Inspeclion O�e� Than RougMn: ❑ R Now ❑ Will Call
��� �' (You must call the inspectw when ready) Date Ready: %�/
I, �censed confractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sheet, Box� or Route No.) � City Zip Code
5 ss i P � ST. �'R i� C,E 55 �3�
Secfion No. Township Name or No. Ranpe No. Fire No. Coun
Occupant
Jo� �v�
P�, s����,
Elechicyl C� �p��y Name� �,
T�
Maili Addreu (Conh w Performing InsM1
.�D9<o ��e�t�. --
Author�' d Signature (Con or Owner Performing
/ �
&OOOOIA-11 8/96 STATE BOAR
Phone No�/ — �OO �
s
IConhacfor License No. I Nlaster Lic. No. (Plant Elect. Only
e�av 9�0
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�^� Phone No.
�i15�-33.2 5
�E N UCTIONS ON BACK OF YELLOW COPY