P - 83866� REQUEST FOR ELECTRICAL INSPECTION
.• ± 1 9� Q 8 O Minnesota State Board of Electricity
1821 U �
Commercial
"X" above the
niversity Ave., Rm. S-128, St. Paul, MN 55104
Phone (612)642-0800
Duplex Apt. Bidg. Other: New
Industrial Farm Remod
Htg. Equip. Water Htr. Load Mgmt. Other:
Range Elec. Heat Temp. Service
covered by this request. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall - 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/Remote Control
Swimming Pool
I hereb certi fhat I ins ted }he elec}rical insfallafion described herein on the dafes stated
Irrigation Boom `-� Rough-In Date
Special Inspection
Finol pa
Investigative Fee d �Q _�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHSJ
OFFICE USE ONLY This request void 18 months from validaticn dafe prinfed in this box.
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Requesf Date ��^ Rou h-in ins ection re uired?
�•1 , �� 9 P q ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Will Call
LJ— / (You musf call the inspector when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
1o�d�s �Sheet, Box, or Route No.) - C'h,� I� _ I Z���' '
U� A � A �/: d
Section No. Township Name or N.
Occ nf � ,
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Power upplier
Elechical Conhacfor IComoanv Namel
Range No. — � Fire No.
BLAINE HTG. A/C ELECT., IfVt,.
Mailing Address rf�� Ir��etjon)
1 � MN 55304
„r,.••-�.feT#B�BOAIiD CpPY -. SEE INSTRUCTIONS ON
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Master Lic.
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