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P - 82528�U�9�5-257 � Home Duplex Commercial Industri REQUEST FOR ELECTRICAL INSPECTION � Minnesota State Board of Electricity �L, 3 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 = (651) 642-0800 ww�v.electricity.state.mn.us " � ,4 Apt. Bldg. Othe �`� ` New Addn Farm � Remod epair Air Conditioner Hig. Equip. Water Hfr. Load Mgmf. Ofher: 1 Dryer Range Elec. Heaf Temp. Service "X" above the work covered by this request. Enter remarks in this space and ack of the white copy only. � -� I� �o�l C. � t�r�e� . -p � �`�'ST�--� J�,� �z�9--� �-�- y-t�l � � � Calculafe Inspection Fee - This Inspection Requesf will not be accepted without the corcect fee: Other Installations Fee # Service Enhance Size Fee # Circuifs / 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 TOTA�I�^ �-7� Sipn / Outline Ltq. Xfmr. e1-�• � v Swimming P � 1 hereb certi tkat I ins ected the elecfrical installation described herein on the dates stated: Irrigation Boom Rough-In Dafe Special Inspection Firwl Investigative fee �C `THIS INSTALLATION MAY BE ORDERED Dt_ _ ECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONIY This rpuesf void 18 months from validation date printed in this box. iH���iii�ii�iiiiiiii�i�ni�i� ���r�, • * 0 9 2 5? 3* 30- �� PLEASE PRINT OR TYPE Reque� Da � Rough-in inspecfion required$ ❑ Yes o Inspection 01her Than RougMn: ❑ Ready Now ill Call f( You must cal� the inspector when ready Dote Ready: I, icensed ontractor ❑ company ❑ owner hereby request inspection of the above electrical work at: Job Addr s k t, Box, or Roufe City Zip Code ��'� � ��.,/D� .�,��,��� _ Ss`�3� o� No. '� \ ��� ress (Contractor`Company or Owne� r PerForming r q �\ � / _ V n re �Confracfo , Compan r ner Perfori 2 5��9 STATE BOARD COPY No. � fire No. InCv� � i s �� SEE INSTRUCTIONS ON BACK OF YELLOW COPY