P - 81081RE(�UEST FOR ELECTRICAL INSPECTION �
8 0�•� 1�� � Minnesota State Board of Electricity 3
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �.
` Phone (612) 642-0 0� `�'
Home Duplex Apt. Bldg. Other: 5� New Addn
Commercia! 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 white copy only.
,
Calculate Inspection Fee - TFiis Inspection Requesf will noi be accepted without fhe correct fee:
Other Fee # Service Entrence Size Fee # Circuits
Mobile Home Park Stall 0 to 200 Amps 0 to 100 A
Street Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPEC70R�S SE ONLY
Sign/Oudine Lig. Xfmr. �fc� �'l'��' ��"7 �"`~�
Alarro/Remote Control
Swimming Pool
Fee
).DD
I her ceAi that I ins the elechical insMllation dexribed herein on the dates stated
Irrigotion Boo so„gMn Dare i��,
Special Inspec 1
Final �>
Investigative Fee Q '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W HiN 18 MONTHS.
OFFICE USE ONLY This request void 18 months kom validation date printed in this box.
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PLEASE PRINT OR TYPE e
Request Date Rough-in inspecfion required$ es ❑ No tnspection Ofher Thon Rough-In: ❑ Ready Now ill Call
� — DU �You must call the inspector when ready� Date Ready:
I, ❑ licensed confroctor �wner hereby request inspecfion of the above elecfrical work at:
Job Addreu (Skeef, Box, or Route No,) Cify Zip Code
/ . . A 1 1 �-, 1 � r ►.� 1f"'� \ � � °--- � _. _
Section No. Township Name or I
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Occupant
1rQ. t3� �
Power Supplier �
Address (C�nhacfor or Owner Performing Installation)
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� Phone No.
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� rming InsMl ' � Ny A � � . I �� �
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY