P - 80665�
8�1-432
� REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Duplex
New
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ommercial Industrial Form Remod Re
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Tem .$ervice
"X" above fhe work covered by fhis request. Enter remarks in this spl�ce and on the back of the while copy ortly.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps a 0 to 100 Amps �""—
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's use oN�r TOTA
Sign/Oudine ltg. Xfmr.
Alorm/Remote Co�trol
Swimming Pool
I hereb ceAi ihat I ins fed �e elechical insfallation described herein on the dafes sTafed
Irriqation Boom R��N,h.l� n..b
investiganve ree ' � +. �/ � � Q � /
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 monfhs from validafion dafe prinfed in ihis box.
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PLEASE PRINT OR TYPE
�°� � Rough-in inspection required? ❑ Yes ❑ No Inspecfion Olher Than RougMn
��/ �� �You must coll the inspector when ready) Date Ready: �
icensed contractor ❑ owner hereby request inspection of the above electrical work at:
pss Sheef, Box, or Roufe No.) Ci
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Jo. iownship Name or No. Range No. Fire No. County r1
Occupant
Power Supplier
Elechical Conhactor (Compony Name)
DEPENDABLE ELEC i
d �^���'rd%^�
Coon Rapids, MN 55
Phone No.
SEE INSTRUCTIONS ON BACK OF YELLOW COPY
0
No.
Ready Now ❑ Will Call
Zip