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P - 83134RE�UEST FOR ELECTRICAL ��rEC'TtON t6-14 - 7 3 2� Minnesota State Board of Electricity 1821 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 Con .�' Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. ��' R� � r�%' �IU c! 1� � ��o �vc�2 9F' �u�Ni4 Calculate Inspection Fee - This Inspection Request will not be accepted wi►hout the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg./TrafFic $ig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTA SO Sign/Outline Ltg. Xfmr. � Alarm/Remote Control Swimming Pool I hereb certi that I ins ted the eleclrical insmllafion described herein on the dates sroted Irriqation Boom Rouah-In Date THIS INSTALLATION MAY BE ORDERED DISCO`N�CTED IF NOT COMPLETED WITHIN �'8 MONTHS. OFFlCE USE ONLY This roquesf void 18 months from validation date printed in }his box. IIIIIIIIIIIIIIIiIIiIiIH�llllllll� I • ���-� ��'� Iilli � * 0 6 1 4 7 3 2 6* �� PLEASE PRINlT OR TYPE ��� Request Date Rough-in inspecfion required2 ❑ Yes No Inspection Olher Than Rough-In: Ready Now ❑ Will Call �You must call the inspector when ready� Date Ready: � I, �icensed contractor ❑ owner hereby request inspection of the above elecfrical work at: 1ob Address (Sheef, Box, or Roufe No.� Cify � Zip Code N � � . � �`�I Section No. Township Name or No Range No. Fire No. County �, ��1� f��vo k� Occupant f� Phone No. p� 1 / AaJ �� � //�i-- '_ �� �O � " �S�i� � � Mailing Address onhac or or ner P rforming Installafion� � Authorized ' re �Conh r or ner PerForming i stallation) EB-0 A-11 8/96 STATE BOARD C Y- SEE �Plant Elect. Only� � � Y// /v �..3 Pho e No. - /-i�9..3 C OF YELLOW COPY