1640 Covington LaneThrs request void 8 Y
18 rtwnths from 3 a Q. j)"b
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Request Date Fire No. Fough-in InsPecuon
Reqmred?
Neady Nuw Wili Nolity.lnsoec-
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?L,ceased Elecvical Convactor I hereby request inspectmn af abovo
? Ownet electrical work installad et;
or Route No.
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Sveet Address, e C?1y
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ecuon o. Township Na or No. Fange No. County
Occuo?ni (PpINT) Phone Na.
G.- d B r ? r9' 6.-j?
Power Supplier
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Electncal Contractor (COmpanY Name)
/c??, CoMractor's License No.
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r Owner Makine toscatlatwM
Matlmg Address lCOnvaccoT o
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Au/th$Jn?zed S?B ?ure (C trac} /o??/ ?Owne?r M/??+?8? Ins[all ' nl Phone Number
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IJ1NESOTA BTqTE BOARD OF ELECTNICITV ? THIS INSPECiION PEQUEST WILL NpT
d?iggs-MidwaY Bidg. - Room N-191 eE ACCEPTE? BV THE STATE BOARO
1821 11nnversilV A?e., St. Peul. MN 55104 UNLESS PNOPEN INSPECTION FEE IS
Phone (612) 297•2111 ENCLOSED.
u 3? a 3 REpUEST FOR ELECTRICAL INSPECTION [EK"0y°°°'{°('
O?????Sae iastructions tar completinB th;: torm 61back of vell? coPV.
A"X" Be/ow Work Civered by This Request
Adtl Reo. Type ol Bwitling APObancea 1NireA EquiOme-I Wired
ex I I Water
Commercial Bldg. ? fumace Silo Umoatler
?I-rlndustnal Blda. Air CondiUoner ? ? Bulk Milk Tank
q Fae ServiceEntranceSise p iea Feade?s?5?hieetla?e 4 Fee Ci'cuita
[l° Uto200Am s 0 to30Am s 0 to30Am
A6ove 200 qm ?s 31 to 100 Amps o" 31 to 100 Arrias
Swimmin Pool Above 100-Amps Above 100--A-Ps
Transtormers Irrigation Booms Partial: Other Fee
aigna .,"",a? ??.?r.........? 5 ,yA?- TOTAL E
fle,N„ks?,y-.--- (''_ ') r4 ryi- -A ^_ 1"
Rough-m /
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yr
s InsOecbr, hereby
certity thet the above
Finel Oate (
2 - inapection hea been
d
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Y a.
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TilNreyueelmltll8mon11ulrom (,/ L`/'