P - 81251. a �r.-
REQ�� � E�TRICAL INSPECTION
_ �'G�58_292 � Minnesota �d of Electricity
1821 Univers' nue e 5-128, Saint Paul, Minnesota 55104-2993
(651) 64 00 Www,electricity.Stafe.mn.us
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Home Duplex Apt. Bldg. Othe " � New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Mgmt. .` Other:
Dryer Range Elect. Heat p. Service
'X" above the work covered by this requesL Entet re s in this space and on the back of the white copy only.
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Ca/cu/a�e Inspection Fee - This Ins ecti e uest will not be accepted without the correct fee.
Other Installations Fee # Service nee Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 2 mps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above Amps Above 100 Amps
Transformer/Generator INSPEC 'S USE ONLY TOTridrer
Sign / Outline Ltg. Xfmr. `���"� �
Alarm/Remote Control
Swimming Pool
I hereb d that I ins ected the electrical installation described herein on the dates stated:
Irrigation Boom Rouyn rn' Date
Special Insp n ' , �
Investigative Fee F��� Date
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITIiIN 18 MONTHS.
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OFFICE USC'ONLY This request void 18 months from validaGon date printed in this box.
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76,5ZS
*08582926*
PLEASE PRINT OR TY
Request Date Raugh-In inspection required? ❑ Yes � No Inspection Other Than Rough-In: Ready Now 0 Will Call
71/19/96 You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999
STATE BOARD COPY
SEE INSTRUCTIONS ON BACK OF YELLOW COPY