P - 81462REQUEST FOR ELECTRICAL INSPECTION
6���(� �[ Minnesota State Board of Electricity
. J •.� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above t e work cove�by this request. Enter remarks in this space and on
� � K ! ��
of the white copy
Caiculate Inspection Fee - Ihis 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 �j 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Ar
Transformer/Generotor INSPECTOR�S use oN�v TOT,
Sign/Outline Lig. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi thaf I ins the elechical installafion described herein on the dak
Irrigafion Boom RougMn pa�
Speciallnspec �
Fee
� �'�
Final p �
Investigative Fee - � -l� �j
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date printed in this box.
I�IIIIIIIIIIIII', ,II�'I�I������ �`•
�I� �V •�
* 0 6 7 1 9 2 5 6* ��
PLEASE PRINT OR TYPE
R uesf Date Rough-in inspection required$ ❑ Yes �o Inspecfion O�er Than RougMn: ❑ Ready NovfJ�Jill Call
'� '��S (You must call the inspector when ready� Date Ready:
I,•�.licensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Address Sheef, Box, or Route No.� CiIY�� Zip Code
a � e,
Secfion No. Township Name or No. Range No. Fire No. ounry .A ,.
i Po��
i
Name)
I Phone �o. s
1
No. Masfer lic. No. �Planf Elecf. Only)
or Owner Performing Insfallation) � ` �
r or rfo ing In � ;r� ^� � p
J '-� �
Jr,,
STATE BOARD COP JSEE INSTRUCTIONS ON BACK OF YELLOW Coav
�s�
i ���
�