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P - 80972REQUEST FOR ELECTRlCAL INSPECTION �� g���� � Minnesota State Board of Electricity , 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone (612) 642-0800 '� � Home Duplex Apt. Bldg. Other: New Addn Commercial Indushial Farm Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service X" bove the work covere by this request. Enter remarks in this space ond on the back of the whif `���°�1 %% /UtzW F'u hlia �'.� � d�l��. �.� � = Calculate inspection Fee - Tf�is Inspection Request will noi be accepfed without the corcecr fee: Other Fee # Service Entrance Size Fee # Circuits/Feedi Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Am s Above 100 Transformer/Generator INSPECTOR'S USE ONLY TC Sign/Outline Ltg. Xfmr. Alarm/Remote Control Swimming Pool copy only. 0 I hereb certi that I ins ted the eleclrical installation descri6ed herein on the dates stoted Irriqotion Boom R�„��„ �� Fee I THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. _j— __------ -----------.—_.___ _ OFFICE USE ONLY This requesi void 18 months from validation date printed in this box. � • �� il� Illlillill!!!!lIIIII�!l118��1�!!� * 0 B 2 8 4 3 7 4* 6C�'�I,?j PLEASE PRlNT OR TYPE Requ=sl �aie � Rou h-in ins cfion r uired? g pe eq ❑ Yes No Inspection Olher Than Rough-In: ❑ Ready Now Wilt Call �You must call Ihe inspector when reody) Date Ready: I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Addr ss heet, Box, or Rou No.) Ciy Zip Code .5 � � � 'Yn �..p-Ir i �• �� ! Section No. Township Name or No. Ranpe No. Fire No. C oN� � on / C :r Sup ier // �� i rical Contmcior (Company Mailing Address (Conhac(� 1�o�.sun� � � � Phone No. � - ` � � 4 8� Address � oSra c, 5-C� oi ..eD i`I/� S r Name Contracror License No. Master Lic. No. �Plant Elecf. Only) �'.r�c�" 1G G � Ol � Owner PerForming Ins Ilafion) i � c �0 �(�-I Q, � �r or ner P horm' stallation) Phone No. � -�3�-�0�6 STATE BOARD CO Y- SEE INSTHUCTIONS ON BACK OF YELLOW COPY