P - 82228REQUEST FOR ELECTRICAL INSPECTION -
8 r� ����/� Minneso!a State Board of Electricity
�� � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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. Phone- (612)_ 642-0800 :. , '��
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Home 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.
%��X� W %
Calculate Inspection Fee - This Jnspection Request will not be accepted without the correct fee:
Other i�ee # Service �ntr Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 0 Amp 0 to 100 Amps
$treet Ltg./Traffic Sig. Abo e 200 Am s Above 100 Amps
Transformer/Generator INSaeCroR'S USE ONLY TOT L
Sign/Outline Ltg. Xfmr. � $ � � � �D•�� ,�`
Aiarm/Remote Conhol '
Swimming Pool
I hereb certi that I in the elechical inslallation described herein on ihe dates stafed
Irrigation Boom Ro�9Mo Dare
Special Inspection
final D �
Investigative Fee - `�p -�^ ��-U'
THIS INSTALLATION MAY BE ORDERED DISCONN IF NOT COMPLETED WITHIN 18 MONTHS.
� � -- OFFICE USE ONLY This requeSt void 18 monfhs from validafion dafe printed in this box.
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0 1 6 4 4 6* �
PLEASE PRINT OR TYPE
Request fe Rough-in inspeclion required$ ❑ Yes No Inspecfion Ofher n Rou Mn: Ready 1Jow � Will Coll
5 ia o� �You must call the inspector when ready) Date Ready: �
I, � icensed contractor ❑ owner hereby request inspecfion of the above elecfrical work at:
Job Address �Sheef, Box or Ryyte No.) Ciy Zip Code
(��.o f �- �� : �1 � �r ►� 55`f�3-
Secfion No. Townzhip Name or No. Ranpe No. Fire No. Counly
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Address �Confracbr or
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY