P - 80711REGIUEST FOR ELECTRICAL INSPECTION --w�.
�� r1 �, ��� � Minnesota State Board of Electricity
'" v �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
me Duplex Apt. Bidg. Ot er: New Addn
Commercial Industrial Farm .S� /LC Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. pther:
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 without fhe correci fee:
Other Fee # Service Entran ize Fee # Circuits/Feeders Fee
Mobile Home Park Stali � 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ,..
$ian/Oudine Lta. Xfmr.
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tlwt I insoected the elechical
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1he dales sw�ed�
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Investigative Fee ' f ✓
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This requast void 18 months from validafion date prinled in this box.
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* � 5 3 � 3 5 3 ��S PLEASE PRINT OR TYPE ���
Requesf Da�e Rough-in inspecfion required? ❑ Yes o Inspecfion Olher Than RougMn: ❑ Ready Now ill Call
S^ 9. (You must cnll the inspecror when ready) Date Ready:
I, �censed contractor ❑ owner hereby request inspecfion of ihe above electrical work aY.
hb Address �Street, Box, w Route No.� City Zip Code
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Seclion No. Township Name w No. Ranpe No. Fire No. CounN .
ailing Address (Conhacfor or Owner
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�thorized Sianalure (Contracror or O�
Phone No.
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Contracbr License No.
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STATE BOARD COPY - SEE INSTRUCiIONS �,@ACK OF YELLOW COPY
No.
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