4245 Heine Ct
0030338y
Requesl ? te
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Fire No.
Rough-In Inspection Requlretl
(YOU must call inspecta? hen atly)
re
Inspeccian Other Then ough-In
? Reetly Now Will Noti(y Inspec(or
?? Z Y ? Ves No
o Date Reatl
IKlicensed contractor ?owner heraby request inspection ot above eledrical work at:
Job AOdre s(Slreet, Box or ute No.)
y5 f?,ki.e ??• City
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Section No. Township Name or No. Range No. Cou?
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Occup9?lr P INTI f n ?
?
?' Phone 6N?/-v? :I
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Power Suppl?i r Atltlrass
Elecinral Cor ractor (COmOany Name) Conlroctors License No.
'YR ,lir-S lcrC f.C?? 1 NG. O S?L6o ?
Mailing Atltlres
s (Conlracmr or Owner Making Inatallallon)
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0 1
mAuthonzetl Sig Phone Number
y-? -0;pov
MINNESOTq STATE BOARD OF ELEC76ICITY THIS INSPECTION REOUEST WILL NOT
Griggs-Mitlway Bldg. - Room 5128 BE ACCEPTED BY THE STATE BOARD
-1821 Unlversity Ave., SL Peul, MN 55109 UNLESS PROPER INSPECTION PEE IS
? Phona(612) 6420800 ENCLOSED.
003 3 8
5?39(C
REQUEST FOR ELECTRICAL INSPECTION
10- Sea instmctions for mmyeting thislorm on back oi yeilow copy.
"X" 8e/ow Warkfovered by This Request
Ne uilding A? .ances Wired Equipment Wireo
Range ` Temporary Service
Water Heater Eleciric Neating
g
w Dryer load Management
shiai Fumace Other S ecify)
Air Conditioner
ContracMrs Remarks:
specify)
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits
s Fee
Swimming Pool 0 to 200 Amps 0 to 700 A
Transformers
Above 200-Amps
e 100 mps
t
Si ns InsPecmrs use oniy: L ?.d
lrrigation Booms -?j ? ?-
5 ecial Inspec
tion
Alarm/Communication THIS INST IATION M DERED DISCONNECTED IF NOT
Other Fee COMPLETE MONTMS.
I, the Electrical Inspector, hereby Rough-in Date
certify that the above inspection has
been made. ai Date
OFFICE USE ONLY
This requ¢st voitl 18 monihs imm