P - 81932r REQUEST FOR ELECTRICAL INSPECTION
C3 V�� — 2 6 7� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 " '
Home Duplex Apt. Bldg. Othert iVl 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 whiie copy only.
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Calculaie Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Serv' tranc ize Fee # Circuits/Feeclers Fee
Mobile Home Park Stall 0 t 200 mps 0 to 100 Amps j%�
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA� ���
Sign/Oudine Ltg. Xfmr. �
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins ted the electriwl insmllation described herein on the da�es stated
Irrigation Boom RougMn /
Special,lnspection ZG^ d `
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 monfhs (rom validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required$ ❑ Yes �No Inspecfion Other Than Rough-In: ❑ Ready Now�Will Call
7 � 'U �You must call fhe inspecfor when ready� Dafe Ready:
I, ❑ licensed confractor �owner hereby request inspection of the above elecfrical work at:
Job Addreu (Sheet, Box, or Roufe No.� CiN T., r..ao
�
Name or No. � I Range
Occupant
Add�eu (Conhacror or Owner
�/�� ,
ed SignaNr� (Conhactor or O�
�..(01.��� �
Phone No.
C� c�� �-� I =
License No.
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IA-11 8/96 57ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY