P - 84539-
�+ RE(�UEST FOR ELECTRICAL INSPECTION ----
��! Ci � 15 2 Minnesota State Board of Electriciiy
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home
Commercial
"X" above the work covered by
s����e��
Apt. Bldg. Uther. New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. $ervice
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 accepfed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic $ig. Above 200 Am s Above 100 Ar
Transformer/Generator INSPECTOR'S USE ONLY TOT�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriqation Boom
}hat I inspecfed fhe elecfrica) installation described herein on the dafes stated
Fee
�
Final
Investigative Fee - — .—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This ret{uest void 18 months (rom validafion dafe printed in fhis box.
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* � 4 6 8]i 5 2 4�k LEASE PRINT OR TYPE ���
R��� �°�e Rough-in inspection required? ❑ Yes No Inspecfion Olher Than RougMn:
y`� j r �� (You must call the inspector when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address �Sheef, Box, or Route No.� City
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Seclion No. Township Name or No. Range No. Fire No. County
Occupant
t-lvdE�
�I Conhacfor �Company Name)
arrison Ele
Address (Conhacror or Owner
Ins�allafiOn)
Zip
Phone No.
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No. � Masfer
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Now 0 Will Call
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Eg�� OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY ����„
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�O°°��°Y r-- STATE BOARD COPY - SEE INSTRUCTIONS ON �ACIZ OF YELLOW COPY ` "' "_ `-