P - 84629- REGIUEST FOR ELECTRICAL INSPECTION �-4�
4� 5� 2 O 1 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Re ir
Air Cond.� Htg. Equip. Water Hfr. 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 Inspeciion Fee - This Inspection Request will not be accepted withou► the correct fee:
Other Fee # Service Entrance Size Fee # 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 ON�Y TOT/4�� �
Sign/Oudine Lig. Xfmr. � t
Alarm/Remote Conhol
$Wlmmin9 POO� I hereb certi that I ins ed the electrical installafion described herein on the dates staled
Ir�igation Boom R�9M� �re
Special Inspec
Final _
Investigative Fee � / _
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COIIAPLETED WITHIN MONTHS.
OFFICE USE OPILY This requesf void 18 months from validafion date prinfed in this box.
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* � 4 9 5 2 0 L 6* PLEASE PRINT OR TYPE
Requesf Date Rough-in inspeclion required$ ❑ Yes No Inspecfion Olher Than R Mn: . eody Now ❑ Will Call
�`fou must call fhe inspec�or when ready) Date Ready: �
I, �licensed contractor ❑ owner hereby request inspection of the above elechical work at:
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