P - 824208:���-227 �
Home Duplex
Commercial Industrial
Air Cond. Htg. Equ
Dryer Range
"X" above the work covered b
RE(�UEST FOR ELECTRICAL INSPECTION ""
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �r
Phone(612)642-0800
Apt. Bldg. Oth :�) �� ew Addn
Farm � w d Remod Re air
Water Htr. 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 Requesi will not be accepted without the correct fee:
Other Fee # Service Entran ' e Fee # Circuits/Feeders
Mobile Home Park Stall �.0 t 200 mps 0 to 100 Amps �
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Ai
INSPECTOR'S USE ONLY
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimminq Pool
Fee
�JV
the electriml installation described herein on the dates stated
_ niiyuiwn oo, Rough-In
Speciallnspection � x`�^�a
Final Da �
Investigative Fee �6—/ � —�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from va' i n 'n this box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required$ ❑ Yes No Inspecfion O�er Than RougMn: ❑ Ready Now Will Call
�.-� Q� (You must call ihe inspec�or when ready� Date Ready:
I, ❑ licensed contractor p9,owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Bo , or Roure No.) City Zip Code
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY