P - 81246RE(1UEST FOR ELECTRICAL INSPECTION �
8�Q���� � Minnesota State Board of Electricity
v 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 Co . Htg. Equip. Wafer Htr. Load Mgmt. Other: �e,� �GtCB &l F+�cS�
Dryer Range Elec. Heat Temp. $ervice ht I�i�.(. AH�+-
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Cplculate Inspection Fee - This Inspection Requesi will not be accepted without the correct fee:
Other Fee # Service Entranc ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps Z 0 to 100 Amps y�
Street Ltg./Traffic Sig. Abo e 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S usE oN�v TOTAL
Sign/Oudine Ltg. Xfmr. '��
Alarm/Remote Confro) d��
Swimming Pool
I here ceAi that I ins the elechical installation described herein on the dates stafed
� Irrigation Boom RougM� Dar C
Special lnspecf ' � � Z' � ��� /
filioE � Date � �
Investigative Fee '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 month om validation date printed in fhis box.
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PLEASE PRINT OR TYPE "
Requesf Dafe RougMin inspecfion required$ ❑ Yes No Inspecfion 011ier Than Rough-In: Ready Now � Will Call
� �',.'�` � (`/ou must call the inspector when ready) Dale Ready:
i, �,licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Slreet, Box, or Route No.) Ciy Zip Code
/g�-�fuer F.� Wa �YL� �-�r��
Seclion No. Township Name or No. Range No. Fire No. County
��'l0 �
Occupant Phone No.
1�e+-"r f"f �I I �� S72 -�+973
Powe� $upplier Address
:�
Elechicnl Conhacfor,Company Name� Conirocfor License No. Master Lic. No. (Planf Elecf. Only)
�'i's�c rr�c' ��o�y8g
Mailing Address (Coniracfor or Owner Performing Insfallafion�
,�7ao �"% ��v e �s/ � • �'!?h . �S.S.3 9�
Aufhorized Signafure �Conhacfor or Owner Performing fi Phone No.
- /� �r.�--s�/-9.�-0
EB-0 1 A-11 8/96 STA BOA COPY - SEE INSTRUCTIONS ON HACK OF YELLOW COPY