P - 83051RE(�UEST FOR ELECTRICAL INSPECTION
6�}% � �` /� Minnesota State Board of Electricity `a
�! "I �� V�F � 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 Hk. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculafe Inspection Fee - This Inspection Requesi will not be accepted wifhout fhe correcl fee:
Other Fee # Service Entrance Size �ree # Circuits/Feeders Fee
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 ONLY TOTAL/
Sign/Outline Lig. Xfmr. ` Q�
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins ihe electrical installafion described hereia on the dWes sfated
Irrigation Boom RougMn Date
S�ecial Insoecti� L� .l .� - .
_THIS INSTALLA710N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 from validafion dafe printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required2 ❑ Yes �No Inspecfion Other Than Rough-In: ❑ Ready Now �Will Call
Sa�.�' q� (You must call the inspector when readyJ Date Ready:
I, � licensed controctor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or R No.) City Zip Code
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Secfion No. Township Name or o. Range No. Fire No. Cour�ly �
Occupanf
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Phone No.
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Name) � � Conhacfor License
ihacbr or Owner Perforr
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(Conhocfor or(�/p.n� er PE
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STATE BOARD CO��/ SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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