P - 82383REQUEST FOR ELECTRICAL INSPECTION -
6 V�� 7 61 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
+ " Phone (612) 642-0800
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heot Temp. Service
"X" bove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspeciion Request will not be accepted witF�out tfie correct Fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Pee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use ON�v TAL �_.
$ign/Oulline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
IrriQation Boom
I herebvi certifv tfwt I
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ihe eleclrical installation described herein on the dates stated
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1& months from validafion date printed in lhis box.
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PLEASE PRINT OR TYPE ��� v
Request Date Rou h-in ins on r uired?
g pecfi eq ❑ Yes o Inspection O�er Than Rough-In: ❑ Ready Now ill Call
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I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.� City�" Zip Code
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Section No. Township ame or No. Ranqe No. Fire No. univ
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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