P - 83208REQUEST FOR ELECTRICAL INSPECTION w;��.
6����[� � Minnesota State Board of Electriciry
, J 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
e Duplex Apt. Bldq. Other: New Addn
Commercial Industrial Farm emod Re air
Air Cond. Htg. Equip. Water Hh. 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 of the white copy only.
�� � � ����
Calculate Inspection Fee - This Inspection Request will noi be accepted wiihout 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. Ahove 200 Amps Above ] 00 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I her certi that I ins the elecfrical insfallafion described herein on Ihe dafes staled
Irrigotion Boom RougMn Dare
Special Inspection 1 �
Final pu�e
Investigative Fee � _�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in ihis box.
III�IIIIIIIIIIilllllllli�lllllllil�lill�l -�
* 0 6 1 7 3 5 8 7* 03
PLEASE PRINT OR TYPE
� Request Dafe Rou h-in ins fion r uired$ Yes
�� � g pec eq ❑ No inspecfion Ofher Than Rough-In: ❑ Ready Now,�Will Call
� r- �You must call the inspecfor when r � Date Ready: � ��
I, ' ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sfreef, Box, or Route No.) City Zip Code
� � � 2 .�U: �' • . �L c
Section No. Township Name w No. Range No. Fire No. Couny
Occupant
R� t
��
Phone No.
- 3386
Conhacfor License No. I Master Lic. No.
ddress �Contracror w Owner Performing Installation) — ���
' � 1
d Signafure (Cqehacfor or Owner Performing Installafion Phone No.
�_ i ) . . . _ rs e�,
� �
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY