P - 82148� REQUEST FOR ELECTRICAL INSPECTION ��
��� Q Minnesota State Board of Electricity �'
• 9 3 7�� d� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ���
` (651) 642-0800 www.electricity.state.mn.us '' '
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Insiallations Fee # Service Enhance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA �
Sign / Outline Ltg. Xfmr. '
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ecred the eledrical insmllation described herein on the dates stated:
IR14Of10� BOOfiI � !. . R����h-I� Date �
I � Investigative Fee � � � 0� I
THIS INSTALLATION MAY BE ORDERED DISCONN CTED IF NOT COMPLETED WITHIN 18 MONTHS.
�� OFFICE USE ONLY This requesf void 1 S monfhs from validafion dafe prinfed in }his` box.
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* 0 9 3 7 7 9 3 8 * ���
PLEASE PRINT OR TYPE
Request Dofe Rough-in inspection required? ❑ Yes ��No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call
. �.� You musf call the inspetlor when ready Date Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addr (Streef, Box, or Ro No.) City _ Zip Code
� �� � � f �� �S 3 Z
Secfion No. Township Name or No. Ranpe No. • Fire No. Couniy �
Power
Electrical Contracfor / Company Name
BI.AtNE HTG. A/C
Mailing Ad en _. � _ _ _
L ���
Address
EI.E(rF., tNC.
o P g Installafion)
I 55304 .
!l1 Y w Il.�
Phone�� � �� (^� ^ �
U�
Masfer Lic.
iaf� hacfo mpany or OWOer Pertorming s IIafPPon . I�none tumcer �� , al
Y ... �/� � �� )
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5�1999 S7ATE BOARD COPY � SEE INSTRUCTIONS ON BACK OF YELLOW COPY