P - 84709REQUEST FOR ELECTRICAL INSPECTION —�
4 9 4� Q�� Minnesota State Board of Electricity
� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
, j Phone(612)642-0800
Home Duplex Apt. Bidq. Other: New Addn
mercial Indushiai Farm emod Re air� ,
ir Cond. Hfg. Equip. Water Hfr. Load Mgmt. Other. Y_ - - --
Dryer Range Elec. Heat Temp. Service . : _.•— =
"X" above the work covered by ihis request Enter remarks in fhis space and on ihe b ck of th— e�whiie opy on�y��
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Calculate Inspection Fee - This Inspection Request will not be accepted wifhout the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Aml
Transformer/Generator INSPECTOR'S uSE oN�Y TOTA
Alarm/Remote Conhol
Swimming Pool
Irriqafion Boom
Fee
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that I ins the electrical insrollafion described herein on the da�es slated
Dore
Investigative Fee -- '� .! �''�J— `
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT C0IAPLETED WITHIN 18 MONTHS.
OFFICE USE Ol1LY This req�est void I S months 6om validafion date printed in this box.
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* 0 4 9 4 8 7 1 7* PLEASE PRINT OR TYPE
Re9uesl �°�e Rough-in inspecfion required� ❑ Yes �!],[Jp� Inspecfion Other Than RougMn: ❑ Ready Now a
a�You must call the inspecfor when ready� Dafe Ready:
I, [�.litensed contractor ❑ owner hereby request inspecfion of the above electrical work at:
Job Address (Sheet, Box, w Route No.� City Zip Code
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Master lic. No.
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