P - 75747REQUEST FOR ELECTRICAL IN PECTION .,� .
7�J =� 6 5 C� Minnesota State Board of Electricity ��`j/,_(""�
1821 University Ave., Rm. S-128, St Paul, lill(�Y'551
Phone (612) 642-08D0
Home Duplex Apt. Bldg. 01her: New Addn
Commercial Industrial Farm Remod ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. p�e�;
Dryer Range Elec. Heat Temp. Service
°X° above the work covered by this request Enter remarks in this space and on fhe back of the white copy only.
Calculate InspecFion Fee - This InspecFion Request will not be accepted withovt the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 ro 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY AL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool �Q.S�
I here mrti thct I ins ihe eledriml installation deuri6ed herein on the dates staled
Irrigafion Boom Roughdn p�
Special InspecFion
filml p�
Investigative Fee �— – Z �o-cr,�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 moMhs from validation data printed in fhis box.
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PLEASE PRINT OR TYPE
R � Rough-in inspeclion requirad8 ❑ Yes o Irmpection Othar Than ough-In: Ready Now ❑�0 Call
� _ (You must call the inspector when ready) Dote Reody: �i%
I, L'� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo Addrav j5treet, Box, or Route No.) Ciy Zi Coda
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or No. (� � Rcmge No. � Fire No.
Phorre No.
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Elecfrical Contractor (Compairy Name� � Conhnctor Lice No. r Lic. No. (Plant Elecf,
PJGC q� � ,� O
Mailing Address (Coniractor or Owner PerForming Installation) ' _r try�
C/' � (� '��'YS
AWhori Sipn re Nenctor or P rmi� Inatall.�innl � D...... N� '
�.Xl I 1(3 -753'� >
BOARD PY - SEE MSTHUC710NS ON BACK OF vELLOw cnav