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RE�IUEST 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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me Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"X" above the work covered by this requesf. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service EMrance Sae Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�suseoN�r TOTAL
Sign/Outline Ltg. Xfmr. %� ��
Alarm/Remote Control
$wimming Pool
I hereb ceAi ihat I ins eded the elechical ins}allation described herein on the dates stated
Irrigation Boo Rough-In pa}e
Special Insp
Final pa� � Q
Investigative Fee 2.9 `
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
315 �� 8 1 � OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE �`��
Reque afe Rough-in inspection required2 � Yes No Inspecfio� Other Than Rough-In: Ready Now � Will Call
Sg, (You must coll the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�ob �ss'S' f, Boz, or�ute No.� ��E' '� , Cih. �, Zip Code
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$etfion No. Township Name or No. Range No. Fire No. County
Occupant �� �
Phone No.
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Power $upplier Address
Elechic.al Conhacfo� (Company Name) Contrador License No. Master Lic. No. (Plant Elett. Only)
METTLER ELECTRIC CAO 1223 AMO 2589
Mailing Address (Contmdor or Owner Performing Installation) _
1240 46th Ave. N.E. M ls., MN 55421
Authorized Signafure (Conirocfor or O ,erfo mg I tallafio ' . Phone No.
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EB-OOOOlA-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY