P - 81497�
� REQUEST FOR ELECTRICAL INSPECTION �
� J, �_ 7 9 4 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-OS00
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Re ir
ir Cond. Htg. Equip. Woter Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enier remarks in lhis space and on the back of the whiie copy only.
`�% �cua��n ���—i�� �
Calculate Inspection Fee - This Inspection Requesf will not be accepted wiihout the correct fee:
Other fee # Service Entrance ize Fee # Circuits/Feeders Fee
Mobile Home Park $tall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA ��
Sign/Outline Ltg. Xfmr.
�
Alarm/Remote Control
Swimming Pool
I hereb erti that I ins ted the elecfrical installafion described herein on the dates stafed
Irrigation Boom RougMo Do�a
$pecial Inspecf'
Final
Investigative F ,
_ THIS INSTALLATION MAY E ORDERED DIS CTED IF NOT COMPLETED WIT IN 18 MO T S.
�� OFFICE USE ONLY This requesf void 18 monfhs (rom validafion date printed in this box.
��������������������N��NIIIII������� � �5� �
* 0 7 5 1 7 9 4 9* ��7 ��
PLEASE PRINT OR TYPE
Requesf fe � RougfFin inspecfion required$ ❑ Yes o Inspection Other Than Rough-In: ❑ Ready No ill Call
(You musf call fhe inspecfor when ready) � Dafe Ready:
I,�censed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or RoWe No.) �, City �� Zip C�
3 S �
Secfion No. Township Name or No. Range No. Fire No. Counl� ,�
Occupant
Power $ui
Conhocfor
Mailing Ac
Aufhorized
, INC
IL� ense
�bb- 2s�2
Master lic. No. (Plant Elecf. Only
Phon�. � — `
� QV v
nw rrov