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1030 Mckee St CvsXa 1'x` / 0? T 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