P - 83202RE(�UEST FOR ELECTRICAL INSPECTION � �
5�.7 - 015 Minnesota State Board of Electricity
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. Qther:
Dryer Range Elec. Heat Temp. Service
"X" above tf�e work covered by this request. Enter remarks in this space and on the back of the white copy only.
`"� 'R -C. �
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
Transforme�/Generato� INSPEC70R's usE Ow�Y TOTAL �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I in the eleclrical installafion describad herein on Ihe da�es sta�ed
Irrigafion Boom RougMn Da+e
Special Inspecfion'
Final � � ,
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ON HS.
OFFN� I�E ONLY Thia requesf vad 18 months kom validafion date printed in Ihis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspeclion required$ ❑ Yes
❑ No Inspecfion O�er Than RougMn: Reody Now � Will Call
� �You must call fhe inspecbr when r�dy) . pat¢ Ready.
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Roul�e I•k,) C�y ZP C� .
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Secfion No. Township Name or No. Range No. Fire No. Cou
I Occupanf Phone No. _
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racfor (Compony Pkme) . Conhacfor license No. � Masfer Lic. No. (PI
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ss (Conhocto�r erFo ing Inslallafion) -
hafu ontracfi�or r mina InstaNafionl `�. ���� .�
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COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY