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P - 83034REQUEST FOR ELECTRICAL INSPECTION � 6/� Q,�� Z�� � Minnesota State Board of Electricity 4 � 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �; � Phone (612) 642-0800 "�' ome Duplex Apt. Bldg. Other: New Addn C mmercial 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 by this reque E�ter r marks in this space and on the back of the whiie copy only. �� � ��� � Cakulate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Am s Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL/�� SignfOudine Ltg. Xfmr. � Alarm/Remote Conhol Swimming Pool I hereb certi that I ins the elechical installafion dasuibed herein on the dates statad Irrigation Boom RoogMn Dare Speciallnspect' ' Finol ° � � Investigative Fee THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months 6om validation date printed in fhis box. ��I���III�lI�l���l�l��li�i�i�lil���l����ll� +r ��� � D 6 4 8 1 9 9 8* �7,3 PLEASE PRINT OR TYPE Request Da � Rough-in inspecfion requiredi ❑ Yes o Inspeclion O�er Than RougMn: eadv Now ❑ Will Call . I� �ICE Job Ac}drr�sj �� $eclion No. Occupanf Po�. s�r� ��� �You must call the inspecfor when ready) Date Ready: contractor ❑ owner hereby request inspection of the above electrical work at: �or Rou o.) _ ' / Ciy Zip ��i%C'l�G� �� �G iship Name or No. Range No. Fire No. unty � � Q1L �� �i�! �%�-'�4 r Address /J��� v �.....C/G// / / G�� or Owner PerForming I f �� Ktor w Owne n� � STATE 0 Phone No. � �/� aj,.�� � Master Lic. No. (Plant .��� / �tion� / � �j � � i .'.�CI -� /ne //C `�� �r�s�.� � �1 � r - SEE INSTRUCTIONS ON BACK O� �LOW COPY