P - 84737RE(#UEST FOR ELECTRICAL INSPECTION
4`(�1 ���/� O Minnesota State Board of Electricity
L� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone(612)642-0800
Home Duplex Apf. Bldg. Other: New Addn
Commercia) Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by Ihis request. Enter remarks in '�acep�n,d on the back of the whiie copy only.
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Calculote Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stal� 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's usE ON�r TOTA���
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi lhat I ins the electrical installafion described herein on the dafes stated
Irrigation Boom RougMn pa�e
Investigative F ,�"'� � --. 1O�`-Z�— jf'
THIS INSTALLATI ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This roqueu void 18 months from validation date printed in this box.
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* O 4 9 7 7 i O L* PLEASE PRINT OR TYPE J(fr �^ �
R�j�°re�� ^ Rough-in inspecfion required2 ❑ Yes o Inspecfion O�er Than RougMn: eady Now ❑ Will Call
�� �9 �`(ou must call the inspeclor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
bb�dm�ts�StfeeJ,� or R te��� Cs/�� Ciy �+ _/ Zip Code
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Seclion No. Township Name or No. Range No. Fire No. Cou fy .�/'����
�ocupa !� C.� �/' !�� Phone No.
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� Mailing Address (Confractor
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�_',L- Gon or L cyP� rJp� �� Master Lic. No. �Planf Elect. On
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Owner P i� Ilpfion) .�'A' ' �. Ph
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STATE BO D PY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY