P - 81117REQUEST FOR ELECTRICAL INSPECTION
7�� o Q� Q � Minnesota State Board of Electricity
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�� � 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. Fnter remarks in this space and on the back of the white copy only.
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Cakulate Inspeciion Fee - This Inspection Requesi will not be accepied 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
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr. �/N_ 4-! 8-�/
Alarm/Remote Conhol
Swimming Pool
I hereb cerfi thaf I ins the elecirical installation described herein on the dafes sMted
Irrigation Boom Ro�Mn Dar�
Special lns
Investigative ee � �- �"� 2,j—o�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN_18 MQ_NTHS, _
OFFICE USE ONLY This request void 18 months from validafion date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspeclion required$ ❑ Yes �No Inspection Other Than RougMn: �,Beady Now ❑ Will Call
�You must call the inspecior when reody� Date Ready: _
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sheet, Box, or Roufe No. Cily Zip Code
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ig ,4�dress (Conhacfor or Owner 7
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I Installofion) �/ � v� J , I Ph� NO'
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COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY
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