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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
Phone(612) 642-0800
Other: New Addn
�I Farm
uip. Water Htr. Load Mgmt. Ofher:
Elec. Heat Temp. Service
by this request. E,�ter remarks in this space and on
„� �ii�v�.�
ite copy
Calculate Inspection Fee - This Inspection Requesf will not be accepied withoui the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Ar
Transformer/Generator INSPECTOR'S USE ONLY TOT�
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I' B
the elechical
Fee
. J C�
rngation oom R«gMn (�`-7�� ,;� / _
Special Insp � � �^�
Final r �—�
Investigative e —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required$ �Yes ❑ No Inspecfion Ofher Than RougMn: ❑ Ready Now ��II Call
✓ (You must call the inspeclor when ready) Dofe Ready: _�
I, � licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sheet, Box, or RAoute No.) Ciy Zip Code
� S / � J
r
Section No. Township Name or No. Range No. Fire No. nry
Occupant
.'S.P.
Phone No.
3115 CENTER POINT DR
rT'�Y���C",.'L'Y'€ctric y Inc � I`"��'if�'t�'��"
�Conhactor or Owner Performing Installafion)
Jamaca Ave. N. Mahtomedi: Mn� 55115
8/96 • - - — ` �
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY