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Dryer
"X" above the work
•REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0£t00
. Other: New
Industrial Farm 'Remod
Htg. Equip. Water Htr. Load Mgmt. Other:
Range Elec. Heat Temp. Service
overed by tl�is requesi. Enler remarks in this space and on the
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copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entranc ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps G
Street Ltg./Traffic Sig. Abo e 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�v TOTAL
Sign/Oudine Ltg. Xfmr. ' �'
Alarm/R�mote Conhol
Swimming Pool
I her certi that I in the eleclriwl installation described herein on the dates s�ated
Irri�ation Boom RooaMo ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE U� ONLY This request wid 18 months kom validaficn date printed in this box.
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* 0 5 2 3 8 8 0 3 �K pLEASE PRINT OR TYPE
R��� � Rough-in inspeclion requiredi ❑ Yes ❑ No Inspecfion Ofher Than Rou Mn: Ready Now ❑�II Call
� a �You musf call the inspecbr when ready� Dafe Ready: '�
f, licensed contractor ❑ owner hereby request inspection of the above electrical work ah
.bb Address (Streer, Box, or Route No.) . Ciy Zip Code
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Section No. Township Name w No. . Range No. Fire No. Coun
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ontracaw or Owner Perfaming
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e IConhac�w or Owner Pe^ ormi Insta 'on� . j1� ���. I p
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BOARD COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY
Confracfor License
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