P - 84772�T J. `r'� O m
Home Duplex
ercial Industrial
Air Cond. Htg. Equ
Dryer Range
"X" above the work covered 6
REQUEST FOR ELECTRICAL INSPECTION -�� '
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
� Phone (612) 642-0800
Apt. Bldg. Other. New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on
the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feed rs Fee
Mobile Home Park Stall 0 to 200 Amps 5 0 to 100 Amps .5
Street Ltg./TrafFic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�v TOTAL
Sign/Outline Ltg. Xfmr. - »
Alarm/Remote Conhol � ��m� ��j.S'�
$wimr�fing Pool �
I hereb certi fhat I ins ed the elechical installafion described herein on the dates sMtad
- 'I�rigativn Boom 6 Rough-In Dore
Speci6l InspectiofM�
Final po ^� ^ S
Invesl4gative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFlCE USE ONLY This requesf void 18 months kom validation dafe printed in }his box.
�
IIIIIIIIillllllllll�llllll111'llllllllllllllllllll ��� �
� .��
* O 4 L O O 8 9 �* PLEASE PRINT OR TYPE
Request Dafe Rough-in inspection required2 ❑ Yes
❑ No Inspection Ofher Than Roughan: . Ready Now ❑ Will Call
���� 7 ,.
�You must call fhe inspector when ready) Daffi Ready:
I, , icensed contractor ❑ owner hereby request inspection of the above electrical work at:
l06 Address (Streef, Box, or Route No.) � Ciy Zi � C«JB
P
� SZ� �- �'�r�C
Section No. Township ame or Ranqe No. Fire No. CounN .
Power
��
Phone No.
ise No. Master Lic.
Cs 7 3
Insfallafion)
'ertorming InsfollofionJ E a � {� �. ,� p
ie� :i lJ
�� �._ �
BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
��,�r �