P - 82946REQUEST FOR ELECTRICAL INSPECTION
5`� ��, C O O Minnesota State Board of Electricity
J J O 1821 University Ave., R�8, St. Paul, MN 55104
F Phone (612) 64 ��00�
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. 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 white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correci fee:
Other Fee # Service Entrance Size Fee Circuits/Feeders
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Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps �lJ�
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL '�
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the eleclrical inslallafion described herein on the dales sfafed
Irrigation Boom Rounh-In Daee
Final
Fee . _ .�.
THIS INSTALLA�IiiA�ORDERED DISCONNECT'ED IF NOT COMPLETED WITHIN 18 MORTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date printed in this box.
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* 0 5 3 2 5 � 8 9* PLEASE PRINT OR TYPE
Re9� �� Rough-in inspeclion required8 ❑ Yes ❑ No Inspeclion Olher Than RougMn: � Ready Now ill Call
3 '�3 �'ld (You must call the inspector when ready) Date Ready:
I, ❑ licensed contractor �wner hereby request inspection of the above elecMical work at:
J�� m Sfreet. Box, or Route No�) � Ciy �t Zip Code
/ � d� �-�cc- � SS4�32
Secfion No. Township Name or No. Range No. Fire No. ounty �
� � ,¢ �va�,�it
°�upant Phone No.
c��v�4P�.� /V%b��e� T�_ 7g'�- 77G2
Power Supplier
Eleclrical ConhacMr (Company Name�
� �t!'�G �
Mailing Addreu�tractor or Owner
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A�hori� Signature (Conhacror or O�
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STATE BOARD COPY - EE INSTRUCiIONS ON BACK OF YELLOW COPY
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