P - 81046REGIUEST FOR ELECTRICAL INSPECTION
C��r� �` 6 O 0 Minnesota State Board of Electricity
� 1821 University Ave., Rm. S-128, St. Paui, MN 55104
� Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commerciai 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 white copy
Calculate Inspection Fee - This fnspection Request will not be accepFed withoui Ihe correc► fes:
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 Amp:
TransFormer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. XFmr.
Alarm/Remote Conhol
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THiS INSTALLATION MAY BE ORDERED DRSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ON�Y This request wid 1 B monfhs from validation dafe prinied in this box.
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Requesf Daie Rou f�-in in ey
9 ���� � u�reed? ❑ Yes o Inspeclion 01her Than RougMn: ❑ Ready Now � Will Coll
3� ° �'ou must caA the inspector when ready� Da� Ready:
I, ❑ licensed conhoctor �owner hereby request inspection of the above elecMical work at:
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SecKon No. Township Name w No. Range No. Fire No. Couny
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g Add�ess �ConMacrvr � Owner Pe�fwming Installatioq�,
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A � � 8�96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COCY
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