P - 844294 w� r�� O^ REQUEST FOR ELE RICAL INSPECTION —
J p L�. Minnesota State Board Electricity '� �"" `
1821 University Ave. m. S-128, St. Paul, MN 55104
Phone (612) 642-0 0 '
Home Duplex Apt. Bldg. Other: ••
Commercial Industrial Farm Ne�'�' Addn
Air Cond. tg. Equip. Water Htr. Load Mgmt. Other: Remod Re ir
°X° °bove the work co�vered by this req esiHEnier remarks in this space ond on �he
back of the white copy only.
Calculate Ins RD����c�.e-►, � � �- �gg�
pection Fee - This Inspeciion Request will not be accepted without the correct fee;
�e� Fee # Service Entrance Size F�
Mobile Home Park Stall Circuits/Feeders Fee
0 to 200 Am s
Sheet Ltg,/T�aFfic Sig. P 0 to 100 Amps
Above 200 Amps
Transformer/Generator Above 100 Amps
Sign/Outline Lt9, Xfmr. �NSPECTOR'S USE ONLY
TOTA �
Alarm/Remote Control
Swimming Pool �
Irrigofion Boom I hereb certify thot I insoecr�i r6e d....w:__� ..�� _ .
��ugo-m --- � nerem on fhe dofes sTafed
pecial Ins ` � oa�
Investigative F�^��
THIS INSTALLqT10N M �' �--��. Z
— ----_____ __ E ORDERED DISCONNECTED IF NOT COMPLETED ITHIN 18 MON HS.
OFFlCE USE ONLY This requesf void �18 monihs from validation date prin�ed in this box.
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R ��re PLEASE PRINT OR TYpE
� 1�.� Rough-in inspecfion required2 ❑ Yes
v� (You musf call fhe ins ° Inspeclion p1F�� Than RougMn:
pector when reody) Dafe Ready: ❑ Re°dY Now Will Call
�. licensed conhactor ❑ owner hereby request inspection of the above elecfrical work at:
1ob Addreu (StrQeF, gox, w R
� � oute No.)
. n�,r,e (.k. Or, �`"
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'on No. iownship Name or No. l ����
Range No. Fire No. ���T �J
Couny . �
y� I Phone No.
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13562 CER3TRAL AVE vN.E �� Co"�`°`�°` �"�"� No.
Master lic. No. �Plant
Mailirg Address C tr �
( aclor or Perfo �
AWhorized Si � e�Conh r or r�Pe.6.,_:-- _. „.�
'` �.,/4 � W �/\�'� 1� t,/ Phone No.
�r�. - �.� � �
EB OOOOI A-11 8/96 ��
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY