P - 82896REQUEST FOR ELECTRICAL INSPECTION -
5���� O� Minnesota State Board of Electricity -
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104
. Phone (612) 642-0800
Home Dupiex Apt. Bldq. Other: New Addn
Commercial Indushial Farm
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 the
Calculate Inspeclion Fee - This Inspe
Ofher Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
will not be
� Above 200 /
INSPECTOR'S USE ONLY
without the correct fee:
Fee # Circuits
s.� 0 to 100 A
Above 100
copy
Fee
7 —
Swimming Pool
I certi thal I in the edechical installafion described herein on 1he dates sta�d
Irrigation Boom Ro�Mn Dore
Special Inspectio r` :'
Finol le
Imestigative fee — ZZ
THIS INSTALLATION MAY BE ORDERED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE 11iE ONLI/ This requsst vad 18 months kom validafion dafe printed in this box.
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Request fe Rougltin inspection required? ❑ Yes ❑ No In n Other Than Rou Mn:
� �� specho g ❑ Ready Now ❑�II Call
(You must call the inspector when ready) Dafe Ready:
I, licensed conhactor � owner hereby request inspection of the above electrical work ah
Job Address (Street, Box, or RoWe No.) . Ciy Zip Code
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Section No. Township Name or� . Ranpe � Fire No. Counly
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IOccupanr`
Conhacfa �Company Ncme�
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\dtlre��Contraclor or Owner Performing Mstallalion)
Phone No.
GIZ ,S l-Cj
�racror license No. Moster lic.
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f ) : . Phone�No.
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/96 S7p BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY