P - 830546?v-05� �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt.8ldg. Other: New
Commerciol Industrial Farm Remod
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 wf�ite copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. ,�
Alarm/Remote Control
Swimming Pool
1 her certi fhat I ins the eledtlEa! installation described herein on the dales st�
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Fee
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Investigative F f` Z6 �
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPlETED WITHIN 18 MONTH�.
OFFICE USE ONLY This requesf wid 1 s from validation date printed in this box.
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� PLEASE PRINT OR TYPE
Requ f Date � Rough-in inspeclion required$ ❑ Yes � No Inspecfion Olher Than RougMn: ❑ Ready Now�Will Coll
ou musf call the inspector when ready� Date Ready:
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job res Sh t o or Roufe No.) City � Zip Code
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� Occupant
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or Owner
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� 8�96 � STATE BOARD COPY - SEE
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mfracror License No. Moster Lic.
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ON BACK OF YELLOW COPY