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P - 80943REQUEST FOR EEECTRICAL INSPECTION �'��� ��� 0�(� � Minnesota State Board of Eleciriciry l) 1821 UniversiTy Ave., Rm. 5-126, SL Paul, MN 55104 Phone (672) 642-OS00 � Home Duplez Apt. Bldg. Ofher: New Addn Commercial Industrial Form Remod Re air Air Cond. Htg. Equip. Woter Htr. Load Mgmi. Other. - Dryer Range Elec. Heaf Temp. Service "X" obove the work covered by /his request. Enrer remor�s in /his space and on Ihe back of Ihe whi�e copy only. ' (�P1.�`s` 60� ��� F-,� � ; �; � J � Colcula�e lnspec�ion Fee - ihis lnspecfion Request will nof be accepfed withouf rhe mrrecl Fee: Other Fee k Serv'ce Entranc ize Fee # Circuits/Feeders Fee Mobile Home Park Stall ) 00 Amps - ,S. �/ 0 fo 100 Amps Sfreet Lig./Traffic Sig. Above 200_Am s Above 100_Amps Transformer/Genemtor INSPECTOR'SUSEDNLY TQ?���v Sign/Outline Ltg. Xfmr. � Alarm/Remofe Control � $Wimming Poo� I hereb �enl thar I I�s ected �he elecrcical insmllation descnbed herein on the dmex xmted Irrigalion Boom Raugbin pare Special Inspecfion � Flnol Invesligafive fe � '-� THIS INSTALLATION A ORDERED �ISCON TED IF NOT COMPLETED WITHIN 18 M S. IIIII II II II III I II IIIII II �I II III II III �IIII OFFICE USE ONLY This request void I B monihs: lidali� da�e�� ��is box. 7i ��..1 1 70� �— * 0 6 9 2 0 5 0 8* �7� ��j � LEASE PRINT OR TYPE l Reqoes� �ol Roughln inspeclion required2 ❑ Ves Na Inspection Other Thon RoigMn: Ready Naw 0 Will Call �• ��� IYOU musf call ihe inspecior whm ready� DoM Ready: - I, icensed contmctor ❑ owner hereby request inspection of the above elechiml work aF. Job A dress (Sireei, Box, or Rouk No � Ciy �A Zip Code 2- O- S'1` ._o, 13Lvp .�.y SSy�32, Sec�ion No. iownship Name or No. Range Na. Fire Na. Cou ty � !h0 �� 0�� Ocapant Ylwne No. � �'a"AS 0 Y+'� (_or2 S'� 1 Z,0 �% Power Supplier Address � � Elearlml Conk«ror �Campany Noma� Canrcacror Lice�u No. Nws�e� Lic. No. �Plom Elecr. Only) S�2 ✓� � 4-u� a 1 Cu �a 3 Moiling Address (Contmc�ororOwner Performing Insmllalion� '"L3'�' SN�WCwLA G�2- +���` SSO� Au�hori d Signamre (Comroc�w or Owner Pedorming Insmllmion� " Phone No. ����Q �`� 1 1S S' .�� EBpp001h11 8/96 STATE BOMD COPV - SEE INSiHUCAONS ON BACK OF YELLOW COPY