P - 83636REQUEST FOR ELECTRICAL INSPECTION �..
�CJ ��- 7 5 2 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
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Rhone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
C mercial Industrial Farm Remod Re air
Air Cond. . Equip. Water Htr. Load Mgmt. Other:
ryer ' Range Elec. Heat Temp. Service
"X" above ihe,work covered b this requesl. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Se ' ntrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall • 0 2 Amps � " 0 to 100 Amps j L
Street Ltg./Traffic Sig. Above 200 Amps Above 100 A -
Transformer/Generator INSPECTOR�S USE ONLY T
Sign/Outline Ltg. Xfmr. �'r u�Srit.� 6, �%aK�ac� � � � ��
Alarm/Remote Control ? ����� �' � °�7�°� �
SwimmingPool 'j^� �—Zo—��
I hereb certi fhat I ins ected fhe elect'cal insfallation described herein on the dates sfated
Irrigation Boom . RougF�ln _ pyre� � _ � „
� � � I Date �''^/ _ _ rj
Investigative Fee ts,�5¢� ��,�i
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS.
OFFICE USE ONLY This requesf void 1 8 mon}hs from validafi da prinfed in this box.
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* 0 5 1 3 7 5 2 6* PLEASE PRINT OR TYPE
Reques� /},� Rough-in inspection required? Yes ❑ No Inspection Other Than RougMn: ❑ Ready Now ill Call
y�You must call the inspecbr w n ady) Date Ready:
f, V51 licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sfreet, Bo�or Route o.) �, Ciy Zip Code
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Section No. Township Name or No. Range No. Fire No. County�f � i
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or Owne erformin Installation) � � PhoJ
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