P - 82914REGIUEST FOR ELECTRICAL INSPECTION
6/�• Jlr� p p� � Minnesota S1ate Board of Electricity
�� �+ o 0 1821 University Ave., Rm. S-128, St. Paul, MN 55104
. Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service
"X" a ove the work covered by this request. Enler remorks in this space and on the back of the white 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 F
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. � 'S v
Alarm/Remote Control
Swimming Pool `_
I hereb certi that I ins fed the eleckical insfallation described herein on the dates sfated
Irrigotion Boom Rouglfln Dare
Speciallnsp 'o i
Final �
�f1Y@St19UtIV@
THIS IN5TALLATION MA BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe� .�� Rough-in inspection required$ ❑ Yes ❑ No Inspecfion Other Than RougFrin: Ready Now 0 Will Call .
(You musf call Ihe inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
J Addreu (Sheef, Box, or Roufe No.) City Zip Code
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Secfion N. Township ame or No. Range No. Fire No. Coun
�
Occupan Phone No.
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Power upplier � Address
Electrical ConhaMOr (Company Name) Co a Licens�� Mosfer Li . No. �Plant Elecf. Only�
EPENDABL� £L� T ---�3
j� ( tr ��Per��g InsMllation)
on Rapid�, MIV 5 3 .
Authorized $ig�wture actor or Owner Perfor in Instoll ��_s ~-:� Phone No.
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EB-0OOOI A-11 8/9 STA BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY