P - 83113REf�UEST FOR ELECTRICAL INSPECTION ��
5 1 �,.,,, 2 9 9 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 Indushial Farm Remod Re ir
Air Cond. Htg. Equip. Water Hfr. 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.
��owy�aG.t� i��`R'r'�.` o-�`
� Calculate Inspection Fee - This Inspection Requesi will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �Q
Sign/Oudine Ltg. Xfmr. �'
Alarm/Remote Conhol
Swimming Poo)
I he certi That I ins the elechic I insrollaKon described herein on the dates sbted
Irri9ation Boom RougMn �
Special Inspecti � '� ^
Final w � �� �
Investigative Fee
THIS INS7ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request roid 18 monihs from validafion dale prinfed in this box.
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* 0 5 7 5 2 9 9 3 * PLEASE PRINT OR TYPE
Request Dafe � � R Irin ins ion r uired2 ❑ Yes
�oug pecl' eq � No Inspeclion Olher ;han Rough-In: ❑ Ready Now ��11 CaII
�' /a �`fou must wll ihe inspector when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
�� N 1 i e t c e. �T `�1 �'. �F I al � e s S 5� � 1
Secfion No. Township Name or No. Range No. Fire No. . C ly
Noka.
Occupanf Phone No.
Da�e �- I�ohf� No �- M S�hvl'Y� �7�, O 7 L �
friwl Coniracfor (Company Name) Conhpctor License No. Masfer lic. Pb. �Planf Elec
'chocn ��+e�7'Hr� Zn� Gfko tG;g -
ling Address (Conhaclw or Owner Performing Installalion) --
1-Z �- T sT 'G!-t �t c G. /J�n y`5'37C
arized Signature �Contrac�or or Owner Performing Installafion) Phone No.
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1A-11 8/96 gTp� gpppD COPY - SEE INSTRUCTIONS ON ACK OF YELLOW COPY