P - 83390REQUEST FOR ELECTRICAL INSPECTION � ,
?��� L+ � C � Minnesota State Board of Electricity
1 Ea U 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `' '
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re 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 this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepied withoui ihe 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 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL T
Sign/Outline Ltg. Xfmr. ��k • Sv
Alarm/Remote Control �
described herein on the dates stated
Investigative Fee � �{9 �+�{�S-�
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection requiredE ❑ Yes ❑ No Inspection Other Than Rough-I � Ready Now ❑ Will Call
/`� ' 9� (You must call the inspecfor when ready) Date Ready: -
1, icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job ddreu �Street, Box, w Roure No.) Ciy Zip Code
� 1/ f) � C.�i: 17i� f iS�:��� �S 3�
� Section No. � Township Name or No. � Ronge No. � Fire No.
I Occupant �%�./ ,�( L HA I,h�" �! `�//SSJ
Masfer Lic. No.
6 ��c
(Confracfor or Own .�ing Insfallation � b j�l �1 ( Phone No. �
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STATE BO PY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY