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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. _��N�I�I�I������III�N�IA�IIII�Iii�llll a�-�BUJ� * 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 - ( .�v s v C7ATF Fi(lAii _ V SEE INSTRl1CTION OF VELLOW COPV