P - 79489U-��9-29� �
REQUEST FOR ELECTRICAL INSPECTION r�y'`�'•°'�'R"+��
Minnesota State Board of Electricity
1821 University Avenue Suile 5-028, SainC Paul, Minnesota 55104-2993 ��
(651) 642-0800 www.electricitystate.mn.us !:c= .
Mgmt.
"X" above fhe work covered by fhis reques[ Enfer remorks in fhis space ond on
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Calculo�e Inspection Fee - ihis Inspection Reques� will not be accepted
Otherinslallations Fee # Service Enhance Size Fee d <
Mobile Home Park Stall 0 to 200 Amps (
Slreet Lfg. / Traffic Sig. 1 I Above 200_Ampsl I I�
Transfarmer/Genemtor TNSPECTOR'S USE ON�Y
copy
wifhouf fhe correct fee:
rcuits / Feeders
fo 100 Amos
Swimming Pool V V 1 _
I hereb cenl thor I ms ecied the electriml ins�ollato� descnbed herein on Iha dores s�afed:
Irrigolion Boom Rough-In Dme
Speciol Inspection � �' 2� ��/
Fnal �.. Dale-�_ . G"Lt
InvestigotiveFee �-�- �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
` OFFlCE USE ONLV Thls requesl void I 8 months hom validotion dale printed In this box.
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PLEASE PRINT OR TVP��
Re s�Da� 9 pec require � pe i g y �
�°� _�� O/ Roe h In Ins tion d2 Yes ❑ No Ins q on Oiher Than Rou h In: ❑ Read Now will Call
LYou mus� mll Ihe inspxror when ready Dote Raody:
1, �licensed contra<ror ❑ company ❑ owner hereby requesf inspection of the above eleclrical work af:
iob nad,e,. �snear, eo., o� aowe No � ay n, eoae
/�3�/ itzc�tk�9�/ P� 1��-tz�b�/ 55�/a/
I Senion No. I Township Name ar Na I Range No. I Fire No. yCouny ^�
I �1
n [] �% P � Q
Ottu an� J Phone No.
�t��vu.�` 76,3 ` 57l -�!
/�/ /8
ElMrical Conimcbr / Company Nome
Z7�- �c.��'rt�-+.E..
AAoiling Address �CoMmdor, Comparry or Ow�er Perf
9 v ct�z
Amhoi e �Commc�or, Company or Owner
4V C �7f �, /'VI/ rj5�/2�'j
mllolionl Phone Number
(612) 3�8 3fJ
SEE INSTNUCTIONS ON BACK OF YELL