P - 83437REGIUEST FOR ELECTRICAL INSPECTION "���
7 n��� 7 C � Minnesota State Board of Electricity 3
CJ J 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �'
� Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial I dustrial Farm Remo air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis 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
Mobile Home Park Stall 0 to 200 Amps / 0 to 100 Amps
Street Ltg./Traific Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL`�—^
Sign/Outline Lig. Xfmr. ��
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins the elechical installafion deuribed herein on the dates sfated
Irrigafion Boom Ro„ah-tr, Dare
Final / ' j�a� �( ��
Investigative Fe � L /I G /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date prinfed in this box.
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* 0? 0 6 6 7 5 6* �Q�3
LEASE PRINT OR TYPE
Requesf M/ —�� Rough-in inspecfion required2 ❑ Yes No Inspecfion Ofher Than Rough-In: Now 0 Will Call
�You musf call the inspector when ready � Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job dress (Sheet, Box, or Route No.�/1 � Ci Zip Code
Db �� n� i')v� l� � ��'��/ l�
Seclion No. � Township Name or
Power
Phone No. �
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or
1 8/96 STATE BOARD COPY - S6E INSTRUCTIONS ON BACK OF YELLOW COPY