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Licensed Elecvical Contractor
Owner
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I I?Ready Now MWill NoLty Insuec-
No [or Whyn Heatly
I heraby request inspechon oi ebove
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Convamor"s License No.
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-^-+?'aiwi[ uURNU OF ELEC CITY
Gngga-Midway Bldg. - Room N491
1e21 UniversiN Ave.. St Paul. MN 56104
Phona (672) 6420600
REQUEST FOR ELECTRICAL INSPECTION
' Spee mstruct?ans lor completnng Ihis foim on bnck of yellow copy.
U. V?pO 5 3 p "X" Be/ow Work Covered by This Request
rT-,-,-_-
THIS INSPECTION qEDUEST WILL NOT
BE ACCEPTED BY TNE STATE BOAqD
UNLESS PPOPEN INSPECTION FEE IS
ENCLOSED.
EB-00001-06
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CS 2 34 2 7 ,°„?'
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Fequest Date Fire No Rou -i ?nspection
Re0 ?eatly Now ? Will Nottly Inepector
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] Ves Na 1
WhenReetly
x hcensed contrector ? owner hereby request mspection of above electrical work at:
Joe Aoaress ISheet Box or oute No 1
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Section No TownSM1ip Name or No Rarye No Gounty I /?
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OccupantlPRINT
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MailingAOtlressiGOnVacl orQwnerMaking,lnslal hon?
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Autnonzetl Si ure (Conlr r ner Ma'eing Instaiiaoan?
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MINNESOTA STATE B011FD OF ELECTFICITV THIS INSPECTION REOUEST WILL NOT
Griqgs-Mltlway 8bg. - Raom 5•173 9E ACCEPTEO 6V TME S1ATE BOARD
1621 Oniveniry Ave_ SL Paul. MN 55106 UNLESS PPOPER INSPECTION FEE IS
Phone(61Y)6C2-0B00 ENClOSEO
REQUEST FOR ELECTRICAL INSPECTION ? eeq-ooom-oe
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i
See msUUCOOns tor completing this form on Oeck ol yailow copy 2`'g=s' /Q /
K 23427 ^x?? aeinw Work Covered bv This Request ?{V
ew Atltl Rep. Typeof8uild?ng APPliancesWiretl EquipmentWired
vice
S
Home Range er
Temporary
Duplea Waier Heater Electnc Heating
Apt Bmlding Dryer Otheo (Spe ty)
Comm.llndustnal Fumace
Farm Av Conditioner
OIM1er (sVecdyl Conlmdors Femarks
Campure lnspecuon Fee 8elaw'
u Other Fee 8 Service Envance Sze Fee # Circuits/Feeders Fee
Sw?mmmg Pool 0 to 200 Amps 0 to 700 Amps
Transformers A6ove 200 - Amps Above 100 - Amps
Signs mspedor's Use Onty TOTAL ?T
Irngahon Booms
Special Inspection
AiarmlCommunication THIS INSTALLATION MAY BE OROERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby FougM1-in
-, , Oete
certify that the above inspecllon has
6een made. F,?ai oa?e ?i __y
OFFICE USE ONLY
Tnis request voiE 18 montns Irom