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Home Duplex
Commercial Indushi
Air Cond. Htg. Ec
Dryer Range
„X" above ►he work covered
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REQUEST FOR ELECTR�CAL INSPECTION -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other. n���1 � New Addn
Farm �G Remod Re air
Wafer Hh. Load Mgmt. Other:
Elec. Heat Temp. Service
Ihis requesf. Enier remarks in this space and on the bock of the white copy only.
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Calculate Inspection Fee - This Inspection Requesf will not be accepted without the correct fee:
Other Fee # Service Entra Size Fee # Circuits/Feeders Fee
Mobile Home Park $tall 0 to 0 Am � 0 to 100 Amps
Sheet Ltg./Traffic Sig. Abo 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�S USE ONLY T�
Sign/Oudine Ltg. Xfmr. �,QQ
Alarm/Remote Control ��'��'O
Swimming Pool
i hereb certi tha� I ins the electrical installafion dexribed herein on ihe da�es stated
Irrigatiow Boorn Rough-In pa�
nnai
Investigative Fee �'t - `�- Z— �
tHIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT CO�APLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months kom validafion date prinled in this box.
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Requesf DoM Ro h-in ins on r uired$
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I, �censed conhactor ❑ owner hereby request inspection of the above elecfrical work at:
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Secfion No. Township Name or No. Range No. Fire No. County
Occupant
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Power Supplier
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Electrical Conha for (Company Name)
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Nailing Addreu (Conhacfor or t9wner Pe/(orming Inslallalia
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4Whorized Signature (Conhacfor r�w perform' �ns
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IPhone No.
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Conlractor License No.
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Mas�er Lic.
Now � Will Call
Zip Code
SSy 21
Only)
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