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-,� � ; �;
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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�
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* 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
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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.
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EBpp001h11 8/96 STATE BOMD COPV - SEE INSiHUCAONS ON BACK OF YELLOW COPY