P - 79883REQUEST FOR ELECTRICAL INSPECTION
8`� �- 3 3 6� Minnesota State Board of Electricity '3
1821 University Ave., Rm. S-12S, St. Paul, MN 55104
Phone(612)642-0800
ome Duplex Apt. Bldg. Other. New Ac
Commercial Industrial Farm ji e� Remod Re
Air Cond. Htg. Equip. Water Htr. Lood Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" obove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Colculate Inspection fee - This inspeciion Request wiii not be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transfo�mer/Generator INSP�CTOWS USE ONLY T��� w �)
Sign/Oudine Lt . X�rnr. 4�j � ��' � ��_
Alarm/Remote Control + � `-' `� � � `
Swimming Pool �
I hereb certi thof I i the electrical installafion dexribed here�
Irriqation Boom ao��ha� _ _ �.
- - - - - Final �W�. -�'�� Q
Investigative Fee (>
THIS INSTALLATION MAY 8E ORDERED DiSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 mon�s (rom validation dafe prinfed in this box.
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PLEASE PRiNT OR TYPE 1`
Request Dafe Roogh-in inspection required2 ❑ Yes
❑ No Inspection Other Than RougMn: ❑ Ready Now Q Will Call
(You must call fhe inspector when ready� Dafe Ready: .
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Sheet, Box, or Route No.) City Zip Code
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$ecfion No. Township Name or No. Range No. fire No. C nly
Occupanl
L� r(
Power Suoolier
Maili� Address (Conhactor or Owner PerForming Insfalfation)
�Contracror or
Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Lic. No.