P - 82407REQUEST FOR ELECTRICAL INSPECTION —
���� 19 0 Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
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 ►he back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted wifhout the correct fee:
Other Fee # Servi e Entrance �ze Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Abo e 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT� ���n
$ign/Outline Lig. Xfmr.
Alarm/Remote Control
Swimminq Pool , ,
the eleclrical installation described herein on the dafes sMted
Investigative Fee � 'f
THIS INSTALLATION MAY BE ORDERED DISCONNECYED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Da � DD Rou h-in ins on r uired$ ❑ Yes
g pecli eq ❑ No Inspection Other Than RougMn: ❑ Ready Now 0 Will Call
�`/ou musf call the inspector when reody) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or RoWe No.) Ciy Zip Code
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Secfio No. Township Name or No. Range No. Fire No. County
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Elechical C frac�(or �
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Mailing Add s(Conhac1Alor w Owner
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- SEE INSTRUCTIONS ON BACK OF YELLOW
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