3241 Donald Ave - Electrical Permit310 -641
19 OFFICE U E ON }Y This m oezl void 18 mamhz from valldafion dote limited in this box
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PLEASE PRINT OR TYPE
Roque pe C Rough-in inspection requked2 Yez o Inzpecfion Oder Than Rough-I?rNow 0 WII Call
j (You most call the inzpecror when readyl Oole Reodp
Icensed contractor ? owner hereby request inspection of the above electrical work at:
Job Address (Sheet, gas, or RouN .) citv? Zip Code
117 7 ,
54/
Section No. Township Name or No. Range No. Fire No. Ca U" ..
O P
1 ant
P
r
Po sr Address
EI Con (Company N Convaaor License No. Meabr Lic. No. (Ploot Elea. Only)
5
Moiling Addell Owner Pero allafion) /
Aanhorix Sill (Convertor or,Ow doming in Hinton) Phone
EB-00001A-10 6/95 / STATE BOARD COPY -SEE INSTRUCTIONS ON BACK OF YELLOWCOPY / /?
II II II I II II II II I II I I I II REQUEST FOR ELECTRICAL INSPECTION Q
Minnesota State Board of Electricity
1821 University Ave., Rm. S-1 8, t. Paul. MN 55104
* 0 3 c 0 6 4 L 6 t Phone (812) 842-0800
ome Duplex Apt Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
it Cond. .Equip. Wafer Htr. Load Mg-t. Other:
Dryer Range Elec. Heat Tem . Service
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Enhance Size Fee # Circuils/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps ove 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY
TO
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I heeb ceni that I ins the ele nsl°Ilation described herein an the dotes slated
irrigation Boom Rough -In Date
Special Inspection
Investigative Fee Fi°al D°
THIS INSTALLATION MAY BE ORDERED DISCO NECTED IF NOT C LETED WITHIN 18 M NT S.