P - 832075.�-L-499 ��
i
Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTiON- -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bld . bther. � �-�.1� New Addn
Farm S od ir
Water Htr. Load Mgmt. Other.
Elec. Heat Temp. $ervice
request Enter remarks in this space and on the bock of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted withou► fhe correct fee:
Other Fee # Servi Entrance ' Fee # Circuits/Feeders Fee
Mobile Home Park Stall 200 ps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am"s �Q3-100 Amps
Transformer/Generator INSPECTOR•s use oro�v .y� TOTAL /
Sign/Oudine Ltg. Xfmr. /J�� ���,� - �� �a� � �fO'S 0
Alarm/Remote Control c,
s�
Swimming Pool �/��� � % �
I here certi that I' the el I installation described herein on Nfe 7al�es �
Irrigation Boom Ro„9M„ , Doyei�� _
Special Inspecti �
Final � ry
Investigative Fee ` ' / /Y�-�
THIS INSTALLA N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
. OFqCE IISE ONLY This requeaf vad 18 months from validation dWe prinfed in liiis box.
� �. 50
IIIIIIIINNIIII�Il�NIIIIIIIIIIIIINII�II �ooa
* � 5 3 2 4 9 9]� * pLEASE PRINT OR TYPE
Request � RougfFin inspecfion required? ❑ Yes ❑ No Inspeclion O�er Thon RougMn: ❑ Reody Now ❑�II Call
� s - Qg (You must call the inspecbr when ready� Date Ready:
i
I, ❑ licensed contractor ❑ owner hereby request inspecfion oF the above electrical work ah
.bb Addreu (Streer, Bwc, or Route No.) Ciy � 7�p Code
f.� aoo �s'�,�.-�1�-�-r' �c� s5� 32-
� SecKon No. Township Name or No. Range No. Fire tJo. C
3� � A�
Occupant � � r-� . Phone No.
�c�,�,e,r �I'cA.�vl°c�'C. � 5'''7 �- —O �1 � �
Power Supplier �� � P Addreu � � �
L �,
Eleclrical Conhac�or (Company Name) ntraaor ticenae No. Masrer lic. No. (PIaM Ekct. Only�
ts�.i �
lubiiina Address (Cnabacfor w Owner Perfnrmir� Installalion)
�Lr"1 � �/ C '�
STATE BOARD COPY - SEE �ISTRUCiIONS ON BACK OF YELLOW COPY