P - 82585REQUEST FOR ELECTRICAL INSPECTION
8 2 6� L O Q P Minnesota St �e Board of Electricity ������
� � 1821 Universi Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �_,�.,
Home Duplex Apt. Bldg. Other: Y j v c� G New faddn
Commercial Industrial Farm Remod e ai.
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice ' ``� �'' '
"X" abov the work covered by this request. Enter remarks in this space and on the back of the w ile copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps O`'—
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S uSE oN�v TOTA
Sign/Outline Ltg. Xfmr. (7.
Alarm/Remote Control
Swimming Pool
I hereb certi fhaf I ins ecfed the electrical installafion described herein on the dates staled
Irrigation Boom Rough-In pa�e
Special Inspection
Investigative Fee Finol Date�� d ��
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_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 8 months from validation date printed in this box.
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PLEASE PRINT OR TYPE �`l �- �'E s•,i
Requesf Date Rou h-in ins ection re uired?
9 p q ❑ Yes No Inspection Other Than Rough-In: ady Now � Will Call
Zfj �� (You must call the inspecfor when ready� � Date Ready:
I, �cens contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Streef, Box, or Route No.) Cily Zip Code �
/a '� � c��.�r t+ ;�� ,,�� �'s-�y3
Secfion No. Township Name or No. Range No. Fire No. Coun ./1
Occupa
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Power Supplier
Mailing Ad�ss (Contractor or Owner
Phone No.
Conhactor License No. Master Lic. No. (Plant Elect.
�Ul� �
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or Owner
Phone
A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY