P - 82754RE(�UEST FOR ELECTRICAL INSPECTION
6������ � Minnesota State Board of Electricity
1821 University 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
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enler remarks in this space and on the back of the white copy only.
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Calculafe Inspeciion Fee - This Inspection Requesi will noi be accepfed withouf the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's use ow�Y TOTAL/S�
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I he�eb certi fhat I ins the elechical installafion described herein on the dafes sfated
Irriqation Boom a,,,,,,i,.i„ �r�
nnm .. / Lc.. —2.. 1 � @�
investigative F�e '
THIS INSTAtLAT10N MAY ORDERED ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 16 monihs from validation dafe printed in fhis box.
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* 0 6 0 2 3 5 0 1* Q70
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? ❑ Yes
� � ❑ No Inspecfion Olher Than Rough-In: Ready Now ❑ Will Call
�You must call fhe inspecror when ready) Date Ready:
i, licensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job ress (Sh t, Box, or Route No � /� Ciy � Zip Cod�e/
L J�/. � SSSCj
Secfion No. Towns ip Name r Range No. Fire No. Coun
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���Pa�� f'� Phone No. /
I Power
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Installafion)
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY