P - 80829REQUEST FOR ELECTRICAL INSPECTION � �
8('� �;� 'j �� � Minnesota State Board of Electricity
�j •L 1821 University Ave., Rm. S-128, St. Paul, MN 55104
. �
� Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm �/11f� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. ther:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the whiie copy only.
Calculate Inspection Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimmina Pool
rn Request will rot be acce
# Service Entrance Size
0 to 200 Amps
Above 200 Am
INSPECTOR'S USE ONLY
�,'...tn� s`�.6�
ri�- �
without the correct fee:
Fee # Circuits/Feeders
0 to 100 Amps
Above 100 Ar
Fee
TO
a'
installation described herein on the date� ���
Final I D�� j_ n
Investigative Fee �Cac�t.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 1 ONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request _ te Rouglrin inspeclion required? es ❑ No Inspection Olher Than Rough-In: eady Now ❑ Will Call
(You must call the inspec�a when ready) Dale Ready:
I, � licensed contractor �S( owner hereby request inspection of the above elech�ical work at:
lob Address (Skeef, Box, or Roufe No.) Cily Zip Code
53D� �¢h �f N� �hrc�J� ssya t
Section No. Township Name or No. Range No. Fire No. Counly
Occupant
�/P�r.c t� e v► �'P v� �'
S � Addre
(Conhacror or Owner
Phone No.
(o/a- soa-�7a. i
Masler Lic. No.
or Owner Pe rmi stall 'bn Phone No.
�'`� ,j Op°L�� 7 0� i
STATE BOARD COPY - SEE INSiRUCT10NS ON BACK OF YELLOW COPY