P - 83314.
6��°1�7 �
Commercial Industrial
ir Co . Htg. Equi
Dryer Range
"X" above the work covered b
RE(1UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 `�'
Apt. Bldg. Other: r�y � ��} New Addn
Farm ��� �' "K� Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
� request. Enter remarks in this space a d on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeder
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 �
Transformer/Generotor INSPECTOR'S USE ONLY TOl
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ted the elechical installation described herein on the da
Irrigation Boom RounMn oore
i�t
Fee
Investigative Fe r�� - 1� --�� V� � J� f
THIS INSTALLA ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE U8E ONLY This roqussf void 18 months from validation da printed in this box.
I�II II I II I I I I I II I II II�IMI�� �� n��� 1�
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* 0 6 8 5 1 8? 7* l��
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required$ ❑ Yes o Inspecfion OFher Than RoughJn: Now 0 Will Call
(You musf call the inspectw when ready� Dote Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo��ss ( t, Bo�r RoWe No.1_ { _ / � �� Ciy � / Zip C � �� .
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Seclion No. Township Name a No. Range No. Fire No. County /� — 1�,, _'
�un,n �`.,ra-
Occupaq �^V �/� `� !�7 ^ i W�) � f_ Phone N�� /� D� �y1
'll/ �yQ .1.1 \n / /' L/ ��(J
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Power Sup lier Ad
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Elechi I C�cto�ompany me�
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M i g A dress (Con�hactor o�er Perfo ing Installafi n��
Avthori Sianature �Conhpc�or or Ownar9=rfor�oin� In;tall �
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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