P - 8180977-�-�03 �
RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(9� 642-0800
Home Duplex Apt. Bldg. Other:
Commercial Industrial 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 back of ihe whif
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Calcubte Inspection Fee - This Inspection Request will not 6e accepted witfiouf the correct fee:
Other fee #. Service Entrance ize Fee # Circujts/FeedE
Mobile Home Park Stall 0 to 00 Am s a 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY tC
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Sign/Outline Ltg. Xfmr. �„�.,��`.� {`� G� �
Alarm/Remote Control
Swimming Pool
.._ ._ _ I herebv terti(v thaf I insoecfed the elechical insfallafion descri6ed herein on the c
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Remod
Date
copy
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Fee
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lnvestigative Fee �
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- OFFlCE USE ONLY This requesf void 18 monihs {rom validafion dafe printed in fhis box.
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PLEASE PRINT OR TYPE �
� Requesf D Rou h-in ins tion r uired?
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(You must call the inspector when ready� Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.� Zip Code
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Section No. Township Name or No. Range No. ounly
Power
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Mailing Address �Conhacfor or Ow
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Phone No.
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S Conhacfor License No. Masfer Lic. No. �
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY