P - 83492. REQUEST FOR ELECTRICAL INSPECTION
����� Q Q Minnesota State Board of Electricity
V`� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
ommercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enier 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 withoui the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY TO
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ecfed the elecfrical installafion described herein on the dafes
Irrigation Boom ,,,,,,,,,,_ _
Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT_HIN 18.MQ HS.__ __�
OFFlCE USE ONLY This request void 18 monfhs from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
R�t D=}e '� Rough-in inspection required$ ❑ Yes o Inspecfion Ofher Than Rough-In
�You musf call the inspecfor when ready) Dafe Ready: ✓
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Ad ress (Streef, Box, or R fe No ) City
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Secfion No. Township Name or No. e No. Fire No. oup1K _
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$upplier
Mailin Address jConhacfor or Owner Pel'Forming Insfallation)
uthorized Signature (C tracfor or Own P orming Insfallation� ��
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EB-00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BAi
Lic.
Now ❑ Will Call
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