P - 83324REQUEST FOR ELECTRICAL INSPECTION `�
7 O 1- 4 2 9 � Minnesota State Board of Electriciiy �
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
y Phone (612) 642-0800 "�'
oaite Duplex Apt. Bldg. Other: New Addn
Commercial dustrial farm Remod Re air
Air Cond. tg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" obove ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
C;���2/�(.,�
Calculate Inspec►ion Fee - This Ins cfio Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use ow�v TOTAL /�
Sign/Outline Ltg. XFmr. �S `r
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elecirical installafion described herein on the dates sMted
Irrigation Boom Rougfrin Date .
Special Inspecti n
fraal Dare 9
Investigative F ,3–��/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe / �� Rough-in inspection requiredZ ❑ Yes ❑ No Inspection Other Tha� Rough-In: Ready Now � Will Call
�, (You musf call }he inspector when ready� Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above elecfrica! work at:
Jo Addr s(Sheef, x, or Roufe No.) Ci1y Zip Code
, S �a
Secfion o. Township Name or No. Range No. � Fire No. County
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Occupanf � � � Phone No. _
Conkxior
or Vwner Yertormi I sMllaM1On) ti V V J1 I rnone rvo.
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STA7E ARD COPY - SEE INSTRUCTIONS ON B LLOW COPY