P - 80826REQUEST FOR ELECTRICAL INSPECTION
8��� 5 6 3� Minnesota Staie Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
, � Phone (612) 642-0800 '� �
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
skbv`�bo,n , zz394, ��.c►1--,�
G�
Calculate Inspection Fee - This Inspection Request will not be accepied withov► the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps ,'Z, 0 to 100 Amps °O
Street Lig./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator iNSPecroR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �( ` � �."�
Alarm/Remote Control 6'`Z' �
Swimming Pool
I hereb certi thaf I ins ted the elechical installafion described herein on the dates stated
Irrigation Boom Rough-In Dare
Special Insp
Final te
Investigotive Fee �8 — �" �
THIS INSTALLATION MAY BE ORDERED DIS NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFlCE USE ONLY This request void 18 months from validation dafe printed in this box.
Il�lllllllllillllllllllllliill�ll�lfl�lill� +� �o-�
* 0 8 2 2 5 6 3 3* ���
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required$ ❑ Yes �o Inspecfion O�er Than RougMn: Ready Now ❑ Will Call
$—,z,�q �� 9 �You must call the inspecror when ready� Date Ready:
I, (�licensed confractor ❑ owner hereby request inspection of the above electrical work at:
hb Addreu (Slreet, Box, w Route No.) _ Ciy Zip Code
Seciion No. Township Name or No. Range No. Fire No. � Counly
Occupanf Phone No.
�
Power Supplier Address
Electrical Conhacror �Company Name) Conhador License No. Mt
�
Mailing Address (Conkactor or Owner Performing Installafion�
z.s 5 �. ��' ss9z�
Authorized Signature (Conhocroor or Owner Performin Installation Ph�
I
:&00001 A-1 1 8/96 STATE B ARD COPY - SEE INSTRU ACK OF YELLOW COPY