P - 83504I
65�°700
Home
Comrr
Air C<
Dryer
"X"abow
REQUEST FOR ELECTRICAL INSPECTION r_�..
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New Addn
Industrial Farm Remod
Htg. Equi . Water Htr. Load Mgmt. Other:
Range Elec. Heat Temp. Service
overed by this request. Enter remarks in this space and on the back of the white copy only.
�ti 1-� �l �.U.So►� � �l �l �� $ S
Calculate Inspection Fee - This Inspecfion Request will not be accepied 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
Street Ltg./Troffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator iNSPeCroR�s usE oN�v TOTA �
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dotes stated
Irriaation Boo j��� ] f i c,.,.,.�,., n,.�a
, ' Final ( /'^�� I Daf%%� ��f 7� �
Investigative Fee ��_�� y�/ c
��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONIY This request void 18 months kom validation date printed in this box.
� Ili� �� �II �I I�� �� ��� I� �I�i I� fll �� II� �� �I� � �I�� • fs�
* 0 6 5 8 7 0 0 0* C����
PLEASE PRINT OR TYPE
Reques Rou h-in ins ection r uired?
g p eq ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
(You must call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sfreet, Box, or Route No.� Ciy Zip Code
m �cm. st 101..�. �rl �
Secfion No. Township Name or No. Ranqe No. Fire No. CoupiY _
�hav�:r��� I����lo •IC�o
,.,,N�. I �o�a�fo�C 7�� I Masfer Lic.
N.E.
iing Installafion�
Performin�
/ �,
-