P - 8062580�-276 �
"X" above Ihe work
I Calcala�e
$heel
Transl
REQUEST FOR ELECTRICAL INSPECTION ;�'� ,
Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, SL Paul, MN 55104 "�y;.
Phone (612) 642-0800 ���.'�
� Elea Heaf � � Temp. Service �
request Enfer remarks in fhis spoce ond on the bock oF �he white copy
Fee - Thrs Inspeclion Request will nut be occepled wih5ouf the co�rec� fee:
Fee # Service Entrance Size Fee # Circui[s/Feeders
rk Stall 0 to 200 Amps 0 to 100 Amps
� i Abave 200_Amps Above 100_Ar
� MS.PyE�CpTO 'S IISE ONLY TOT�
Xfmr. �qya�,� ��o—a �i5 c R��•--•� .
,�{.,
onnai
I he.eb cenl �hat I ms ned ihe elecvicol i mll n d 'b d he � th d�
Fee
�Sa
Irrigafion Boom go h,� n' � e$`�� e E„�°""
� I o� � oaie
$pecia� Inspeclion " C�—J--- � /-3- d � �`
Flnol
Invesfi9o}iveFee �O�e�'_�. ^O
THIS INSTALLATION MAY BE ORDEflED DISCONNECTED IF NOT COMPLETED VyITHIN 18 MONTHS.
OFFICE USE ONIV ihis requesl void I B momhs kom valido�ion da�e prinred in ihis box.
� A� �� �l�I I�����l) � �� Ilf�ll ��I� �ilu ���a3a ��i.�a
PLEASE PRINT OR TVPE
RM�r� Rovgh�in inspe:fian requir�2 Yes ❑ No Inspectlon Other Thon RooghAn�. ❑ Ready Now WIII Coll
•'� D� �YOU muS call Ihe In:pecror when ready� Dak Ready:
I, ❑ licenud mntracbr owner here6y request inspection of the above elecfrical work at
Job Address �Sheel, Box, or Rare No I Cly Zip Code
' . _ _ ' . i ._ _...._ _
oryrv�o.
�V
I Ma➢irg Address (Contmdor
1 Gl�h A �c
No.
Phone No.
Lic No.
6?�939 /