P - 835707,3�--979 C�
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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
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Commercia lndustrial Farm Remod Re ai
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reqvest. Enfer remorks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection R st will not be accepted without the correci 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 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. - s�
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins ted the elechical installafion deuribed herein on the dares staled
Irrigation Boom RougMn Dare
Special inspection �!
Investigative Fee f�� -�-- ��p- �7 "'E�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs 6o alidation dafe printed in ihis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes ❑ No Inspection O�er Than Rough-In: dy Now � Will Cal)
� '� �•��� (You musf call the inspector when ready) Date Ready:
I, licensed controctor ❑ owner hereby request inspection of the above electrical work at:
Job Address (S eef, Box, or Rou No.) City Zip Code
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$ecfion No. Township Name or No. Range No. Fire No. Couny
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Occupant /'� Phone No.
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Power
EPENDABLE El
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0011 Rap+ds, MN
�uthorized Signature (Conh,
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;T�tC. INC. `
ing Installafion)
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STATE ARD-� OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY ����