P - 83808�-i9-028 �
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RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, Si. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Vther:
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. Enier remarks in this space and on the back
New
Remod
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copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
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. ' `�v
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted fhe electrical installation described herein on the dafes stated
Irrigation Boom RougMn ��e
Speciallnspectio r-
.j Final �.�,
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS�
OFFlCE USE ONLY This request void 18 monfhs from validaficn date printed in this box.
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Request�pf =���� Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now Will Call
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(You must call the inspeclor when ready� Date Ready:
f, �.licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Ro f No.�y `� City _ Zip Code
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Seciion No. Township Name or No. Range No. Fire No. Countx �
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Power
Elecfrical Conhactor �Company Name�
� HTC3.IV�C ELECT., INC.
Mailing Addres f ion�
t AWQib1. 55304
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ise No.
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