P - 83223REQUEST FOR ELECTRICAL INSPECTION
4 3 9� 8 2 4 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55iO4
� Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm Remod Re air
Air Co�d. Htg. Equip. Water Htr. Load Mgmt. Oiher:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enfer remarks in this space and on the back of the whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepied withoui fhe correct fee. ��2�
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps �Q 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T T.A.�L�+ /�
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�ote Confrol
Pool
I hereb certi that 1 ins ected the
00 Rough-In
herein on Ihe do�es sta�ed
Investigative Fee `" " /
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 ONTHS.
OFFN;E USE ONLY Thia request void 18 months from validation date printed in this box.
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quest Dote �Q Rough-in inspection required$ ❑ Yes No Inspeclion Olher Than RougMn: eady Now 0 Will Call
�ij —�"' / Q (You must call the inspec�or when ready� Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sheef, Box, or R fe No.) City
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Seclion No. Township Name w No. Ronge No. Fire No. Cou�y
Occupanf
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Power Supplier �
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Eleciricnl Con r (Company Name)
H�1�b�75 �z�r�
Mailing Address �Conhacror w. �DrW/ne*AerForming Ins,
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Authori sig�ah,re (�acto. or erfo ��u
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I&OOOOIA-11 8/96 STATE BOARD
Phone No.
6/2 -- S72 —/�;9
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Contracfa License No. Masler Lic. No. (Pla� Elecf. Onlyl
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` SEE INSTRUCTIONS ON BACK OF YELLOW COPY