P - 81488,, REGIUEST FOR ELECTRICAL INSPECTION �
:� 51- 510 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �.
Phone (612) 642-0800
Home Dupiex Apt. Bldg. Other: New
C mmercial I dushial Farm Remod
�ir Co Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks 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 withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps to 100 Amps <
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT �
Sign/Outline Ltg. Xfmr. , <
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ted the elechical installation dexribed herein on the dates stated
Irrigation Boom , RougMn pa�
Special Inspecti
Investigative Fee F� �°� ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO
fee
OFFICE USE ONLY This request void 18 months 6om validallon date printed in this box.
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* 0 7 5 1 5 1 0 9* �'0 7 7
PLEASE PRINT OR TYPE
�uesf Dafe Rough-in inspection required?
� � ❑ Yes No Inspection Olher Than RougMn: Now ❑ Will Call
�� � (You musf call fhe inspecfor when ready� Dafe Ready:
licensed contractor ❑ owner hereby request inspection oF the above electrical work ot:
ddress (Sfr f, Box, or Route t�a.) ���- C�h, �� Zip Code
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lion No. Township ame or No. Ranqe No. Fire N� �,.,,.,.,
co�h«ro.
Addreu (ConhqcYOr or
Phone No.
��y �G
Conhactor License No. MasTer Lic. No. (Plunt Elect.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY