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P - 83788REQUEST FOR ELECTRICAL INSPECTION �« � � Minnesota State Board of Electricity 5� J- 5 2 0 1g21 University Ave., Rm. S-128, St. Paul, MN 55104 , _ .�: Phone(612)642-0800 Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Re air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered b�y is request. Enter remar 'n thjy�space and on the back of the white copy only. /C��% Qi�i� �' � l�Q d'�� ,�/�/l�c�' Calculate Inspection Fee - This Inspection R quest will not be accepted withouf the correcf fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps ,�'� Z 0 to 100 Amps L�,(,� Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOT $ign/Outline Ltg. Xfmr. ��� Alarm/Remote Control Swimming Pool I hereb certi fhat I ins fed the elecfrical insfallation described herein on the dates sfated Irri9ation Boom Rough-In pa� Speciallnspect , � Irnesti9ative Fee � Final - �1-' ef�„ � / THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 1 S months from validaticn date printed in fhis box. IIIIIu�IIII�II��IIIII�IIII IIIIIIIIII � � �9 — . ( IIII * O 5 2 5 5 2 0 �� PLEASE PRINT OR TYPE �� � Request Daf Rou h-in ins tion re uired? '��i iy "") 9 P� q ❑ Yes No Inspection Other Than Rough-In�eady Now � Will Call y/ (You must call the inspector when ready Date Ready: f, icensed contractor ❑ owner hereby request inspection of the above electrical work at: Jo`�b Ad�dr/e�s treet, Box, o Roufe /oJ� City ' Zip Code / < 7 ��('� `` ��C� Section No. Township Name or N. Range No. Fire No. Counry A / Occupanf Phone No. W . ✓CC�O Powe� Suppli Address � J�i`� �/�3` ��'��� �i<� Elecfric onh c r Com�° me) Contr9,ctor License No. Master Lic. No. (Plant Elect. Only� %b� �/� � �c� �� l�� �/�J��� Address �Confractor or Owner P rmii V I, ed gnafur ontractor or er e I -11 8/96 STAT 0 i ^ J ' I37� ��o� YELLOW COPY