P - 84333.
, -�"42-363 =°�
RE(IUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �r
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air 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 whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps to 100 Amps , Qj
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT L
�ign/Outline Ltg. Xfmr. � �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ecfed ihe electrical installation described herein on fhe dates sfated
Irriaation Boom u�,�„ti_i� Dare
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monihs from validafion dafe prinfed in fhis box.
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IIIIIIIIIIIII�IIIIIIIIIIIIIIII III/IIIIIIIII f� �
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* � 4 4 2 3 6 3 8* PLEASE PRINT OR TYPE
Req�st Da Rough-in inspection required? ❑ Yes �o Inspection Ofher Than Rough-In: Ready Now ❑ Will Call
3�a � (You must call ihe inspector when ready) Date Ready
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I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Iob Address (Stty�t, Box, or Route No.� _ Ciiy Zip Code
or
Fire No. � County
No.
(' �
Eleclrical�o�,rr�w�C�c�v N�nell e C t Y' 1 C� I j'1 �,` , I Confracter lic��e{ �O p I Master Lic. No. �Planf Elect. C
l.E� t� c�
Moilings����o��eva°�aPe�`v°��:5�°��Ri°:� #301, Golden Valley, MN, 55�427
Authorized ig a re �Conha or o�n r Pe i g I tallafion) Phone No.
� ��� 5���-3300
B-00001A- 8�� STATE BO RD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY