P - 82910REQUEST FOR ELECTRICAL INSPECTION
� 0����� � 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 Add
Commercial Industrial Farm Remod e air
Air Cond. Ht . Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
► �l�-'� �-1'I�.JU
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe 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 Si . Above 200 Am s Above 100 Amps
Transformer/Generafor INSPECTOR'S USE ONLY TOT� �
Sign/Outline Ltg. Xfmr. '
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elechical installafion described herein on ihe dates stated
Irrigation Boom Rough-In ��
Special Inspe
F;� _3-�
Investigative ee
THIS INSTALLATION MAY BE ORDEREd DISCONNECTED iF NOT COMPLETED WITHIN i8 MONTHS.
- OFFICE USE ONLY This requesf void 18 months 6om validafion date printed in this box.
�N�Ii��lli���l�iiil����l�i�l�lll�il���ll�l�� � ?_ 1spp�
� 0 6 0 4 6 3 7 9* �Jfd 4
PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins ecfion re uired$ ❑ Yes o Ins
� 9 P q pedion O�her Than RougMn: eady Now ❑ Will Call .
��« q �You must call the inspedcr when ready) Date Ra�r:
I, icensed conhacror ❑ owner hereby request inspection of the above electrical work at:
Job Address heet, Box, or Route No.! Ciy Zip Code
�o C.� CC �e..l�--
Secfion No. Township Name or No. . nge No. Fire No. C �
F"�
Occupant Phone No.
�-���C (L Jr1�- qlaq
Power S�pplier Address
Elechical Conkacbr'Company Name) ` Co hacfor License No. Masrer Lic. No. (Plant Elect. OnlyJ
� r v� 5 1�.� �—�-r � a�
39
Moiling Ad ess (Co hacfor or Owner PerFormin nsfalla}ion) �
l � � �.Oi . ,
uth i S n re ( Nactor or Owner Performing Installafion�� ���^ p��.y.
U �� — �
EB-00001 - STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY