P - 84747REQUEST FOR ELECTRICAL INSPECTION •��
4� O� 2/I O Minnesota State Board of Electricity
-r 1821 Uni��ersity Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other:
Commercial Indushial Farm
Air Cond. Htg. Equip. Wate� Hh. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by fhis requesi. Enter remarks in this space and on
New
Remod
the white copy only.
Calculate Inspection Fee - This Inspection Request will noi be accepled without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic $iq. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S usE oN�r TOTAL t�^ t
Sign/Oudine Ltg. Xfmr. p?S -"'
Alarm/Remote Confrol
Swimming Pool
�, . � I hereby certi(y fhat I inspecfed the elecfrical insfallafion described herein on the dates stafed
nnoi �� � C� C�
Imestigative Fee ,� �, _ ,
THIS INSTALLA710N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 monfhs from validation date printed in this box.
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P SE PRINT OR TYPE
Requesf Date Rough-in inspection required? es ❑ No Inspecfion Other Than RougMn: ❑ R Now
eody ❑ Will Call
�-a� � ? �You musf call the inspector when ready) Cafe Ready:
I, ' nsed conhactor ❑ owner hereby request i tion of the above elechical work at:
Job Addreu �Skeet, Box, or Route No.) — Ci `
la� �, s �� 4 y�2��e Z,P��
Section No. Township Name or No. Ronge No. Fire No. County
1��'�� �/%
I Power
� Mailing
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�M��e�pT � FGTM.. �
(W'f+c��r��,• " �1�i�
sdCgnhactor or er PerFdlh�ing Installafion)
Phone No.
License No. � Master Lic.
or �wner t�rtorming Insfollotion) I Phone
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY