P - 84562REQUEST FOR ELECTRICAL INSPECTION >-�:..
�F _� �• 3(� 2 Minnesota State Board of Electriciiy
. 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
liome Uuplex Apt.8ldg. Other: New A�
Commercial Indushial Farm Remod Re
Air Cond. Htg. Equip. Water Hh. 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 fhe whiie copy only.
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Calculate Inspecfion Fee - This Inspection Request will not be accepied without ihe 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 Siq. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
Irrigafion Boom
Soeciallnsoecti .
Lnvestigative Fee � — " � "°°'
THIS INSTALLATION MAY BE ORDERED
elechical insfallation described herein on the dates
JNNECTED IF NOT COMPLETED
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7 — 7�
18 MONTHS.
OFFICE USE ONLY This requesf wid 18 months 6om validation date printed in this box.
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* � 4 5 9 3 9 2 7%� PLEASE PRINT OR TYPE
Requesf Date Rougffin inspection required? Yes
���Q� ❑ No Inspeclion Olher Than RougMn: ❑ Ready Now Will Call
� (You must call the inspector when ready) Date Ready:
I,�icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Ro No.) Ci� Zip Code
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SecNon No. Township Name or No. Range No. Fire No. Cou
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Phone No.