P - 82884r
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' Commercia
Air Cond.
Dryer
"X" above the
REQUEST 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: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter 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 accepted wifhout ihe 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 ONLY TOTALL` ��
$ign/Outline Ltg. Xfmr. /�
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted the elechical installation described herein on the dates stated
Irrigation Boo t Rough-In Dn�e
Special Inspect' �{
Final D
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED �SC ECTED IF NOT COMPLETED WITHIN 1 MONTHS.
- OFFlCE USE ONLY This request void 18 monfhs from validotion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins ion r uired$ ❑ Yes
�,�� -�� 9 P� eq ❑ No Inspecfion Other Than RougMn: Ready Now ❑ Will Call
�You musf call fhe inspecfor when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sf eef, Box, or Roufe No.)� City Zip Code
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Secfion No. Township Name or No. Range No. Fire No. C
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Occupant �� Phone No.
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C h license o. Master �ic. No.
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or vwner rerror n Installation) I Phone No.
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TE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY