P - 82995���`�L-4�9
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Commercial
Air Cond.
Dryer
"X" above the �
Industrial
RE(IUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '�'
Apt. Bldg. Other: i� �'7� New Addn
Farm S emod Re air
Water Hfr. Load Mgmt. Other:
Elec. Heat Temp. Service
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 Entrance Size Fee # Circuits/F
Mobile Home Park Stall 0 to 200 Amps 0 ro 100 Am
Street Ltg./Traffic Sig. Above 200 Am s Above 100_
Transformer/Generator INSPECTOR'S USE ONLY �j
Sign/Outline Ltg. Xfmr. / G; �� �//�C�C ����`"�`� � "T
AlarmfRemoteConhol L j
Swimming Pool ���h
I hereb cerii that I ins the 'rnl installalion described herein a
Irrigation Boom RougMln
Sneciallnsoection .
Fee
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s�ed
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THIS INSTALIATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONI.Y This roq�eat vad 18 months from validafion dafe printed in ihis box.
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* �� 3 2 4 8 9 2�K PLEASE PRINT OR TYPE
Request Date Rou h-in ins on � uired$ Yes
g peMi eq �❑ No Inspeciion Olher Thao RougMn: ❑ Ready Now ill Ca�l
`a (You musf call the inspecror when ready) Dale Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) � Ciy � � Zip Code
� LD �rC�i E' �� �� �
Secfion No. Township Name or No. Ranpe No. Fire No. CouMV �
�r I�
Power Supplier
co�ka�
1
Plrone No.
� � � �
170� V151a'1
Contractor License No. Master Lic. No.
or Owner Perfwming Ins�llafion)
r P�torm � g Installation) �) i� `�� (,�' j Phone No. � �
,� �� e./ tJ �f Fr /—�O
STATE BOARD COPY - SEE INSTRUCTIONS ON BA� OF YELLOW COPY