P - 83899REQUEST FOR ELECTRICAL INSPECTION �
� ,� � � � � � � 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 Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ►his space and on the back of fhe white copy only.
(�ii�.�, �w
Calculate Inspection Fee - This Inspeclion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA� (�p
Sign/Outline Ltg. Xfmr.
Y�–
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected fhe electrical installafion described herein on the dafes stafed
Irrigation Bo Rough-In Date
Special Ins i
Investigative Fee F���I d� %�e Z3 —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPIETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion dafe prinfed in this box.
��ii�ll�lll�l����ll�i�i��l ���� • �� �� �
Illiiilllllll
* 0 4 6 2 2 2 0 5* ���
LEASE PRINT OR TYPE
Requesf afe Rough-in inspecfion required? ❑ Yes No Inspection Other Than Rough-In: eady Now ❑ Will Call
�' �� (You must call the inspector when ready) Date Ready: D
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sireet, Box, or Route o.� City � Zip Code
90 �,�-�C, � nr- G?,c�d `�., d .�s��
Secfion No. Township Name or No. Range No. Fire No. Coun
Occupant Phone No.
J� .S�%i� z. r.s0
0
Mailing Addrlss (Conhactor or Owner Pedorming Insfallafic
I GtI `
Authorized Signature ( onhacfor or Owner Pe ing Insta
�
�
� E&OOOOIA-11 8/96 STATE BOARD CO�
ConhacTor License No.
�*�/ �[i
�T
�� r
fIONS ON BACK OF
Phone No.
78/-,6.�0�
Y
Only)