P - 80988RE(1l1EST FOR ELECTRICAL INSPECTION
—�/1 �°� C, /I Minnesota State Board of Electricity
�f �� �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `' `
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
�( Air C j� Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by tfiis request. Enter remarks in this space and on the back of fhe whife copy only.
S'u��l- 2,3�4- f ►���/C
Calculate Inspection Fee - This Inspecfion Request will not be accepted wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stali 0 to 200 Amps 2 0 to 100 Amps °O
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ��.s�
Alarm/Remote Control
..............� . .....
I he� certi that I ins the eleclrical installation described herein on the dates stated
Irrigqtion Bo RougMn Dare
Special Ins - f
Investigative Fee F�� "z� " ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion dafe printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required? ❑ Yes
No Inspecfion Other Than Rough-In: �Ready Now � Will Call
���B�G�C� �You must call the inspector when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Roure No.) Ciy Zip Code
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Secfion No, Township Name r No. Range No. Fire No. Cou�ly
Occvpant
Power Supp�ier
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Aufhorized
E&OOOOIA
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or Owoer Pe
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itlor or Own�
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STATE BOARD COPY - SEE
Phone No.
4/ 57 - 7�89(0
Conhacfor License No. Master Lic. No.
� Phone No.
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YELLOW COPY