P - 77589REQUEST FOR ELECTRICAL INSPECTION
.rPi�V �� 61 Minnesota State Board of Electricity
— 1821 Universily Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
�C Air Cond. Htg. Equip. +c Water Htr. Load Mgmt. Other: '`/�
Dryer Range Elec. Heat Temp. Service 3
"X" above the work covered by ihis request. Enier remarks in this space and on the back of the white copy on y.
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Calculate Inspeciion Fee - This Inspection Request will not be accep►ed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ,
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Outline Ltg.
•
Alarm/Remote
Swimmin Pool ( CF
9 I hereb cerli that I ins fed the elechical installafion described h ein on thddates e2ta�d C
Irrigation Boom RougMn oare
Special ►nspection Z 'Z —�j
Final '� Dafe
Investigative fee S !" ! � ' � � —°
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT C MPLETED WITHIN �MONTHS.
OFFICE USE QNLl! This request void l 8 months (rom validation prinMd in lhis box.
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PLEASE PRINT OR TYPE
R°�°Sf �° .y Rough�in inspeclion requirodY Yes ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now WiII Call
ar �•� ��' �You myst oofl Ilr in�sdor reody) Dale Reody:
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f, (�licens eonfractor ❑ owner hereby request mspect(ort of the above electrical work ah
Job Addfasa (Sireee, Box, w Roy�No.) Ciy T.�p Code
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