1030 Mckee St
CvsXa
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39 OGA&
Requeel Date Flre No. Roug - nspecnan Requlretl In6 lon Olhsr Tl?en Rou In
(YOU ?,sl call Inspector?en reedy) ?Raetly Nax ? Wi1l No1Hy Lrepector
/ Y ?? ves No Dala RB
1IMlcensed contractor ? owner hereby request inspection of ebove electricel work at:
Job ? rV30 Bax a Route N.)??? ? C'ry
Seciron Na. TownsMp Name or No. Renge No. Counly_
??gCo fp
Occupanl(PRI
? ?.4G>>+ N Pllona No.
Pawer Suppller
? Adtlrasa
Elec1rical Co ira or (COmpeny Neme) ConUecror's Llcerea No.
Meiling tltlreea (COntracror or Owner Making brefallation)
02-0 99 rA« '4U rr! fa,v
Aulharhetl 5igna ra (COM? or/O e n8 Inslell ion)
• Pho•ne,NumOar
/? r??
MINNESOTA STA7E BOAFD O LECTRICT'
pAggsNlAwry Bldg. - Poom 6128
1821 Unlverelry Ave., SL Paul, MN 561o4
PhoM 18121892-0800
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPEP INSPECTION FEE IS
ENCLOSED.
RE4UEST FOR ELECTRICAL INSPECTION ee-00001-09 003 0 3 9? Sae inalrucHOns lor completing Mis tortn on 6eck of yalbw apy.
"X" eelow Work Covered by This Request
Ne% Add Rep. Type of Building Rppllsnceb Wired Equipment Wlred
Home Range Temporary Service
Du Iex Water Heater Electric HeaNng
t. Building Dryer Load Menagement
mm./Industrlal Furnace Other (Specify)
4 rtn Alr Conditloner
(apettly) Conlrectara Remarks:
Other
Compute InspecNon Fee Below:
# ONer Fee # Service Entrance Size Fee # CfrouitslFeeders Fee
Swimming Pool 0 to 200 Am s 0 to 100 Am
Trensformers Above 200_Am s Am
Si ns imae?mrs ua
7 pL ?
Irrigation 6ooms ? 0
Y
S ecial Ins ection
AiarmlCOmmunlcation TH S INSTAL TION MAY NNECTED IF NOT
Other Fee COMPLETE IN 18 ONTHS.
1, lhe Electrlcal Inspector, hereby
ceAify Mat the above inspeclion has
been mede. 11ou9h-In
F,nei oare
oa?y `
?
OFFICE U8E ONLY
Thls request voltl 18 monins Irom