P - 81604����5-263 �
Dryer
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 ���:
(651) 642-0800 www.electricity.state.mn.us '���
Duplex Apt. Bldg. Other: New ddn
Industrial Farm Remod Repair
Hfg. Equip. Wafer Hfr. Load Mgmf. Ofher:
Range Elec. Heat Temp. Service
rk covered by this re remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Requesi will not be
Ofher Insfallations Fee # Service Entrance Size Fee
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
$ign / Outline Ltq. Xfmr.
without the correct fee:
0 to 100 Amps
Above 100
Swimming Pool
I hereb certi that I ins cted the elechical installation described herein on the dates stated:
Irrigation Boom_ Ro„a�-i„ ��e
Investigative Fee ���� � ��t ---� I {�e^� �� ` a �
THIS INSTALLATION MAY BE ORDERED ECTED IF NOT COMPLETED WITHIN 18 MONTHS. _
. � OFRICE USE ONLY This request void 18 m n om��� ' iea-�iate printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes� No Inspection Other Than Rough-In: ❑ Ready No Will Call
1,� �� � You musf call the inspecfor when ready Date Ready:
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job�ess' eef, Box, or � City Zip Code
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Secfion No. Township Name or No. Range No. Fire No. Coun
D/�'�
Occupanf
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Power Supplie� � Address
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Elechic ConMactor / Compan ame �
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Mail ni g Addreu (Confmcfor, Company or Owner Perfor ng Insfallation)
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Au—�z 'gns e(Conhacror, Company or Owner Performing Installc
:B iRTTA-12 5/1999 �
STATE BOARD COP
Ph/on�e No.
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Elect.
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SEE INSTRUCTIONS ON BACK OF YELLOW COPV