3025 Eagandale Pl - Electrical InspectionsREQUEST FOR ELECTRICAL INSPECTION (DEB-OMOI-04
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p, Soe irstruclims Tor a?letin this form on be ' a'-"- copy.
4 4 7 0 5 X'" ee/o t Work Covered Ay. This Request C/LI SU
Add Rep. Trm of Bui Wine Appliances Wired Equiprienl Wired
Water
Farm
e Foe Service EnlranceS¢e % Fee % Fee Circuits
0 to 200 A-PS 0 to 30 Am
Above 200-Am ps M 31 to 100 Amps
Swimming Pool V OO_ Above 100_Am '
Trattstomlers Partial: Other Fee
Remarks Sig ; Special Inspection
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certify that the above
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Request Dow Fire No. Bough-i Ins ction
fired?
?Reatly NowWill Notify
Insper
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or When Ready
Licensed Electrical Contractor 1 hereby request inspection of above
?Owrw electrical work installed at:
Street Address. Boa OF Route No. City
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Lon Township Name or Me. Range No. ty
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Occupant (PRINT) Rhone No.
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Powm Sappher Address y3?i ?av 9r
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Electriol Contractor (Camempo w Name) tractor's License No.
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Mailirp Address (CentraCtor OF Owner Making hstailation)
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Phon¢ Number
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MINNESO1A STATE BOARD OF ELECTRICITY THIS.INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg_ - Room N-191 BE ACCEPTED By THE STATE BOARD
1821 Unhreraity Ave_. St. Pagl. MN 551 04 UNLESS PROPER INSPECTION FEE IS
Phom M121297-2111 ENCLOSED.