P - 80647.
5��-586 �g
Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION � -�
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re air
ip. Water Hir. Load Mgmt. pther:
Elec. Heat Temp. Service
�y this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Ai
TOT
Fce
Transformer/Generator INSPECTOR S USE ONLY
Sign/Outline Ltg. Xfmr. � � �}'� � � G- _�r � • ��
Alarm/Remote Control C1� O --
Swimming Pool
I her certi tlwt I ins leclrical installafion described erem on he a�es s�
Irri9qtion Boom RougMn �v_ � � ?�7 ,qs
Speciallnspec � �
Firwl
Investigative F "'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED tF NOT COMPLETED WRHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 B mo�ths from validation date prinfed in this box.
IIIIINIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIII �/ s� �` ����
* � 5 3 2 5 8 6 5* PLEASE PRINT OR TYPE
RequesT Date Rough-in inspection required$ ❑ Yes ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now � ��11 Call
� q (You must call ihe inspeclor when ready) Dale Ready:
J, ❑ licensed conhactor �owner hereby request inspection of the above electrical work at:
hb Address �Street, Box,ror Roure No.) ,� Ciy � Zip Code
��,3 vJti.�,aew.�,�r� C�r uJ �-�. � ��
Section No. Township Name or No. Range No. Fire No. Couny
�3v � An
Occupant Phone No.
g�-v�.e- A• C, ��- o fc►� s� t- � 3�6
� Power $upplier �, 9 Add ` �1 :
!'V �S /v02.!`?� �/'�Si cr,cJ
Eleclrical Conh (Company Name� � Conhacfor License No. Masfer Lic. No. (Plonf Elecl. Only)
Moiling Addreu (Conhactor y� Owner Pe ��' I°�► � �
��6 �` �, r,�. e. w�.-e..�`�L9 C�.� J' r� �.
Authorized Signature (Contractor or Owner Per(orming Installafion) Pha�e No.
_ L. f��2 S I-
Eg0000 A-11 B/96 STATE BOARD COPY - SEE INSiRIICiIONS ON BACK OF YELLOW COPY