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P - 83542REGIUEST FOR ELECTRICAL INSPECTION s 7�� '-F - 6 6 6� Minnesota State Board of Electricity �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �; 2 �� Phone (612) 642-0800 "�' ome Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Re air 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 only. UV ��r� a5 -�i r�L�.c-er � Calculate Inspection Fee - This Inspection Request will not be accepted without the 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 Sig. Above 200 Amps Above 100 Amps Transformer/Genefator INSPECTOR's use oN�v TOTAL Sign/Outline Ltg. Xfmr. Alarm/Remote Control `5 � Swimming Pool I hereb ceAi that I ins the elechical in ilation described herein on the dates stafed Irrigation Boom r RougMn �� Special Ins � ` � � re Investigative Fee � THIS INSTALLATION MAY BE ORDERED DISCONNECT'ED IF NOT COMPLETED WITHIN 18 MON HS. OFFCE U8E ONLY This req�est void 18 months hom validation date printed i� this box. � �il� �) ��� �� �II �� ��� �� ��I ���� (� ��� �� �__ ��, sa *07246663* ��a9 PLEASE PRINT OR TYPE . Request Date Rough-in inspecfion required? ❑ Yes o Inspection Odter Than Rough-In: ❑ Ready IVow dl CaN �You musf call fhe inspecfor when ready� Date Ready: I, icensed contractor ❑ owner hereby request inspecfion of the above elechical work at: Job Address (Sheef, Box, or Route No.� � r r City � � Zip Code Section No. �'fownship Name or No. � Range � Conkacfor �Company Name) Phone No. � u�. ��n�f�\ec�. �o��. Co. I 1;�00�O10 I - �ress �Conhacfor or Owner Performing Insfallafion� 8+a, .e�.+ �� � Pau I n� N� � o� Si� onhacfor or Owner Performing I stallalion) - Phone N�oj � i� �1 ��, F..' �� � 1—W� W� l ��$�I6 s STATE BOAR COPY - SEE INSiRUCT10NS ON BACK OF YELLOW COPY