P - 82911REQUEST FOR ELECTRICAL INSPECTION �,: �
6/� /� �� p p� � Minnesota State Board of Electriciry
�t 4 o c� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `'�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
te�'"✓' � ,
Calculate Inspection Fee - Thi nspecfion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders F e
Mobile Home Park Stall 0 to 200 Amps 0 to l00 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOWS USE ONLY TOTAL /C .�
Sign/Oudine Ltg. Xfmr. !�
Alarm/Remote Control
Swimming Pool
I hereb ceAi that I ins ted the electrical installation described herein on ihe dates stated
Irriaation Boom Q„��.,�� �ate
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Investigative Fee �C _ _ — �— 2-'��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 monfhs from validation date prinfed in this box.
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PLEASE PRINT OR TYPE•
Requesf pafe Rou h-in ins fion r uired? ❑ Yes
�-� `��- g pec eq ❑ No Inspection Ofher Than Roughan: Ready Now ❑ Will Call
(You musf call the inspector when ready) Date Ready:
I, licensed contracror ❑ owner hereby request inspection of the above electrical work at:
Job Ad�reu �Shee�Box, or Route No.) � Ciy Zip Code -�
75.�
Section No. Township Name or No. Ranqe No. Fire No. CounN _ /
Power
�:
Phone
',�om�i r�n�� 1 V. �' `�- Co ka r License No. Masfer Lic. No.
Rapid: Bivd. NW ������ ��
ih r �r•e �ing Insfallafion�
(Conhact er Performing I - ation) � Phone No.
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AD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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