P - 83345REQUEST FOR ELECTRICAL INSPECTION
7 O`t� 17 2� Minnesota State Board af Eleetrieiiy
1821 University Ave., Rm. S-128, St. Paul, MN 55104
.r Phone (612) 642-0800
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on
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Calculate Inspection Fee - This Inspection Request will not be accepted wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps � c'.J
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPEC?OR'S USE ONLY TOTAL/
Sign/Outline Ltg. Xfmr. ! �'{d
Alarm/Remote Control
Swimming Pool
I hereb certi that i ins ted the elechical installation described herein on the dafes slated
Irrigation Boom Rough-In Dare
$pecipl insp i �
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Investigative ee
` THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe f� Rough-in inspection requiredZ ❑ Yes o Inspecfion Other Than Ro�gh-In: Ready Now ❑ Will Call
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I, icensed controctor ❑ owner hereby request inspectio ,��tabove electrical work at:
Job Address (Sheet, Box, or Route No.� ��_` Zip Code
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- SEE INSTRUCTIONS ON BACK OF YELLOW COPY