P - 82746REGIUEST FOR ELECTRICAL INSPECTION �u
512 - 9 3 5 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 "�"
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
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 fhe back of ihe white copy only.
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Calculafe Inspection Fee - This Inspection Request will not be accepted withoui the correci fee:
Other Fee # Service EMrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stali 0 to 200 Amps 0 to 100 Amps /ly� AJ
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Ge�erator INSPECTOR'S USE ONLY TOT� Q
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool � i he� cer�i that 1 i the eledrical installation dex:ribed herein on �he dares sla�ed
Irrigation Boom . RagMn Daie
Speciallnspecti ,
Find ` �^
Investigative Fee ^
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFRCE 118E ONLY This request void 18 months from validation date printed in this box.
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* � 5 1 2 9 3 5 8�K PLEASE PRINT OR TYPE '
Requesf Date Rough-in inspecfion required$ Q Yes Inspecfion Olher Than RougMn: Ready Now � WiN CaN
�"�Q � 9� (You must call the inspeclor when ready) Date Ready: ��
I, �icensed confractor ❑ owner hereby request inspection of ihe above electrical work at
Job Address (Street, Box, or No. Ciy 7�p C«1e
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Seclion No. Township Name or No. Range No. Fire No. Counry
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zed Signa (C nfracror or er PerForming I Ilafion) Phone No. .
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��p`"� �$�96 STATE BOAHD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY