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P - 82396REQUEST FOR ELECTRICAL INSPECTION f, -�. 8 2�/� �� � Minnesota State Board of Electricity 3 U `t 1821 University Avenue Suite S-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 Conditioner Hfg. Equip. Water Htr. Load Mgmt. t er: Dryer Range Elec. Heat Temp. $ervice "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. �TIT�.Q- 1f�2.c.c.� �a-��v..Q� Calculote Inspec►ion Fee - This Inspection Request will not be accepted without ihe correct iee: Other Installations fee # Service Entrance Size Fee # Circuits / Feeders Fce Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL Sign / Outline Ltg. Xfmr. ll.Lc.l.l��.0� .� � A� Alarm/Remote Control Swimming Pool I here certi that I ins ted the eleckical insfallation described herein on the dates sMkd: Irrigation Bo Rough-In �a� Special Insp Final � Investigative Fee �3 �CX' THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months from va�idation date printed in this box. IIIIIqIN�l11��IlI�I��II����I�I� O r ,� �, S �5��5 0 9 8 2 4 4 7 5� PLEASE PRINT OR TYPE Requesf Date � Rough-in inspection required$ ❑ Yes o Inspection Ofher Than Rough-In: eady Now ❑ Will Call :� �, ', ��fii � You must call fhe inspector when ready � Date Ready: � 1,�4censed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: Job Address �Sheef, Box, or Route No.� City Zip Code I Secfion No. I Township Name or Occupant PaWe� s�� 9ya- s� 28� ompany Name ��.�,�.�:� e cror, Company or Owner Performing acfor, Com ny o ner Pe rJ � STATE BOARD COPY Phone No. L�L Confractor License No. C�� �3to W ��,T,'�c`..�,.Q L►7 Elect. Phone Number I (bSl) SS'3�'�`% INSTRUCTIONS ON BACK OF YELLOW COPY