P - 83089REQUEST FOR ELECTRICAL INSPECTION ��
�O�� Iq �% � Minnesota State Board of Electricity
0 `-� � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
_ Phone (612) 642-0800 '�'
n
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
�, A' Htg. Equip. Water Htr. Load Mgmt. Other:
r 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.
fu,�nac� S�-C�r�a/ r9-i�2 �1J/lc°CTiO/i�
Calculate Inspection Fee - This Inspection Request will not be accepted wiihouf ihe correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps p� °�
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Outline Lfg. Xfmr. � ,, �
Alarm/Remote Control
Swimming Pool
I hereb cerfi that I ins the electrical installation described herein on the dafes stated
Irrigation Boom eougMn Dare
Speciaf Insp '
F'wal
Investigative ;.) � 2.. � d�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This requesl void 18 monihs From validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins ction r uired?
g pe eq ❑ Yes No Inspecfion Olher Than Rough-In: ❑ Ready Now Will Call
y�I.. 9 g (You must call ihe inspector when ready� Date Ready:
I, [� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) � City Zip Code
��3G �i �/ly�ood Lane Fi2�,oG .�-.�-5��2 �
Secfion No. Township Name or No. Range No. Fire No. County
�4,vo,C',�-
OccupoM . Phone No.
G�R i �L�G-Gi.t� .�'7/ - 390 3
Power $uoolier Add.a«
�Confmctor or
u�.
p� 1Q'a
� �U �4� ,9RIl 4�1 �1 ��'�i!
9yner Pe ' g Inst ti . Phone No.
" 2 $� /a-�
STATE BOARD COPY IN UCTIONS ON BACK OF YELLOW COPY