P - 84702REf�UEST FOR ELECTRICAL INSPECTION �
4 9 L: � 611 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
�, Phone(612)642-0800
, Home Duplex Apt. Bldg. th r: New Addn
• Commercial Indushial Farm ��i-� vF � i1(Z,�� Remod Re ir
_ Air Cond Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by fhis requesi. Enter remarks in this sp ice and on the back of the white copy only.
��� i� � C,, �Z. GE; �. � �
Cakulate Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Fee # Service Entraoce Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps S', U
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S USE ONLY �TAL C
A
Sign/Outline Ltg. Xfmr. S � �
Alarm/Remote Confrol
Swimming Pool
I h ceAi fhat I ins the elecirical installation described herein on the dafes stated
Irrigation Boom Rw,9Mn pa�
Speciallnspecti - �
Final _ Z. __. �
Investigative Fee --
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validafion date printed in this box.
���������������I���I1� ��������������I��������I j�� � �
�� �
* � 4 9 2 6 L L 9* PLEASE PRINT OR TYPE
Requesf Dafe R h-in ins on r uired?
oug pecfi eq ❑ Yes �No Insp�fion Olher Than RougMn: ❑ Ready Now ❑ Will Call
�'� i S-- �You must call the inspeclor when ready) Dafe Ready: ��' '7 .� � ��•�
I, �,licensed confractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Streef, Box, or Roule No.� City Zip Code
`4 �J • 'C�,cu.c�. '�
Seclion No. Tow�ship Name w No. Range No. Fire No. Couny
�
I Power
Elechical Conhactor �Company Name) .� R(,Z Q��
�l_.g�,.�i�� !�
AAailing Address (Conkaclor or Owner PerForming Inslallation)
a! � 2 �'ro �t�l+►.� �3.ri
C_./�/L
srnre eonno coPr -
Phone No.
r � �� I 1�
;nse No. Masfer Lic.
0�.,3 C�
� �-�.,� �N g"�'`N 8
. . � i � PKhone No^.
�J e�C ��� ��
'UCTIONS ON BACK OF YELLOW COPY