P - 83239REC�UEST FOR ELECTRICAL INSPECTIOI
�C � G� f1 �� � Minnesota State Board of Electricity
U^ J V i 821 University Ave., Rm. S-128, St. Paul, MN 551 �
1 Phone (612) 642-0800
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Fieat Temp. Service
"X" abov �the work covered by fhis request. er remorks in this space and on the back of the whitE
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Calculate Inspectio ee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feedei
Mobile Home Pork Stall 0 t 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 /
Transformer�Generator INSPECTOR'S USE ONLY TO�
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Conhol �
Swimming Pool
I here cerfi that I ins the electrical insMllation described herein on the d�
Irriqation Boom e��,i..�., n..,�
New
copy
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Fee
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Special Inspect' C' �7 ' '" / l`7 0
Final te
Investigative F 2 ' -�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 1 S monlfis from validaiion date printed in this box.
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No.
PLEASE PRINT OR TYPE
Rough-in inspection required$ es ❑ No Inspection Other Than Rough-In: ❑ Ready Now
(`/ou musf call fhe inspector when ready) Date Ready:
contractor ❑ owner hereby request inspection of the above elecfrical work at:
Bo , o.) �� City � Zip C
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iship Name w No. Range No. Fire No. Couny
1
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No.
Call
�mmg msmnanon� . [1 ("a ��' r; I Y�J� �— 33�5
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BOARD COPY - SEE INSTRUCTIONS �N BACK OF YELLOW COPY