P - 82237.
' REQUEST FOR ELECTRICAL INSPECTION ��
(�'� � C��� C C � Minnesota State Board of Electricity
1��� U �� �J 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
� Air Co er Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
��I��l�°��1 �� �$0�9
Calculate Inspection Fee - This Inspeciio� Request will not be accepted wi►hout the correc► fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / TrafFic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT L
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the elechical installation described herein on the dates staMd:
Irrigation Boom Rough-In Dare
Special Inspection
Investigative Fee Final Date l2„ ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion date printed in this box.
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* 0 9 6 2 2 5 5 6 * ���9
PLEASE PRINT OR TYPE
Requesf Dat= � Rough-in inspection required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: eady Now ❑ Will Call
You must call the inspector when ready Dafe Ready:
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreef, Box, or Roufe. No.) City 1 Zip Code
� � S ` � `�' f t GL
Section No. Township Name or No. Range No. Fire No. County n �
' n � � j / � I Phone No.
License No.
E ELECTRIC. INC.
a vn �FMrn
MN +� 3�
mfractor, Co or Owner Pe
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C7ATF Fi(lAii _ V SEE INSTRl1CTION OF VELLOW COPV