P - 81473� i T � � V V
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REQUEST FOR E���CAL INSPECTION
Minnesota State Bosr9� Electricity
1821 Universily Ave., IT�• S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Hh. Load M mf. (Ter:
Elec. Heat Temp. $ervice
this request. Enter remarks in �his spaceand on the back of the white copy only.
Calculate Inspecrion Fee - This Inspecfion Request will not be accepbd rilhout the correct fee:
Other Fee # Service Entrance Size Pe # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO L
Sign/Oudine Ltg. Xfmr. '� i�
Alarm/Remote Conhol
Swimming Pool _3 P
I hereb certi fhat I ins fed e elechic insfallafion described herein on the dSFe�tat d�
Irrigafion Boom RougMn pa
Special Inspect � •1 t
Final `�
Investigative Fee
_THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF �OT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This recf�est void 18 months from validation dafe printed in this box.
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PLEAiE PRINT OR TYPE
R�� �°� Rou h�in ins ion r uired? '
� � 9 P� eq ❑ Yes �lO I Olher Than RougMn: ❑ Ready Now �11lill Call
(You must call fhe inspector when ready� i R�ady; ��•�
I, �ensed confractor ❑ owner hereby request inspection of the ab�ve elecfrical work at:
Job Addreu (Sheet, Box, or Route N; .�A Ciy � � n Zip Code
Name or No. \ v I Range
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ctor (Company Name)
(Conhacfor or r�r Performing I�
�� ��. ��\�Ia
�lure (Contracfor a Owner Performing Instal6
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TRUCTIONS ON I
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