P - 80350REQUEST FOR ELECTRICAL INSPECTION �
� ^/7^}� Minnesota State Board of Electricity 3
U�� 2 2� L 1 V � �gp1 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
; (651) 642-0800 www.electricity.state.mn.us '� '
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Calculate Inspection Fee - Thi 1 pection Requesi will not be accepted withouf the correct fee:
Other Installations Fee # Service Enkance Size fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. • ,
Alarm/Remofe Control �
Swimming Pool
I hereb ceAi that 1 ins ed the eledrical inslallation described herein on the dates slal
Irriaation Boom o,,,,,,ti_�„ n„�a
' ' Final / ` � I Dgte,� I
Invesfigotive Fee • L �0
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in this box.
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* 0 9 2 2 2 7 8 7 * ��S
PLEASE PRINT OR PE
9Ue5��°� '� Rough-in inspection required2 ❑ Yes ❑ No Inspeclion Other Than Rough-In: Ready Now 0 Will Call
`j You must call fhe inspecfor when ready Dafe Ready:
licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
� ddress (Street, Box, or Rout No.) Ciy /J Zip Code �
/ /�� �5-�� ,,.,.nnr,l �i.�n�. J� � �� ,(/�,, �SS/.3�
Townshio Name or No.
Power
Phone No.
�
No.
2619 Coon Ra�ids Blvd. NW
Signature (Coniractor,�px�any or
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5/1999 STATE 60AR0 PV SEE INSTRl1CTIONS ON B YELLOW COPY