P - 83267REQUEST FOR ELECTRICAL INSPECTION �
4 4 2- 9 5 8 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
, ;.... �:
Phone(612)642-08d0
me Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e ir
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" abov e work covered by this request. Enter remarks in this sppce and o the back of the wi�ite copy only.
l � Z°. f �'1S �[ �� � �' �''(,� i ��-2, � t'��� �_
Colculate Inspecfion Fee - This Inspection Request will not be accepied without fhe correct fee:
Other Fee # Service Entranc ize Fee # Circuits/Feeders f-ee
Mobite Home Park Stall to mps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO A�L^
Sign/Oudine Lig. Xfmr. J
Alarm/Remote Conho)
Swimming Pool
I her cer�i flwt i in 1he elechicai insfallafion described herein on fhe dafes staled
Irrig 'oa Boom RougMn Da�e
Special Ins
Find
Investigative - �s °—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE IISE ONLY 7his requesf void 18 months from vulidation date printed in this box.
�Il�iiliillllllllilllll�iilllllllil IIII � �as�
�� ��� �y��z
* � 4 4 2 9 5 8 5* PLEASE PRINT OR TYPE
R � Rough-in inspecfion requiredZ ❑ Yes � o Inspecfion Ofher Than Ro h�ln: R
ug eady Plow � Wil) CaN
� (You musf call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreef, Box, or Route No.� / City Zip Code
J� dd/�e..Lit , i'/ �d : ,�.�
Section No. ownship Name Q�IO� Range°� Fire No. Co
J�` o
o� � � e�a r�.
�. � 7/-�
ower Supplier q�� �
/t�S �S �CJo ��
E ical Confracror (Canpan a e) / Contracror se NoG v Maslar lic. No. (PIaM Eled. OnFj�
��t�� — �� �/ Cc r. c� ��/!�Q
�Moili dress (Contrac�a w Owner Per{onning Installation) �
CJ� /V l� � �� /" � !�. �.J..�✓
Authori nalure �Contrador or Owner PerFo ' Installalio ' , f Phone No. � � �
�
� � 1 �
EBOOpOIA-11 8/96 �A7E gpppp COPY - SEE INSTRUCTIONS ON BACK OF YEtLOW COPY