P - 82698REQUEST FOR ELECTRICAL INSPECTION -
�} 4.J�o � q 14 Minnesota State Board of Electricify
� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
' Phone(612)642-OS00
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm Remod Re air
Air Cond:" Htg. E ui . Water Htr. Load Mgmt. Other.
Dryer Range ) Elec. Heat Temp. Service
"X" above the work covered y this request. Enier remarks in this space and on the back of the white copy only.
i
Calculaie Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 ro Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�v TOTAL ".S O
Sign/Oudine Ltg. Xfmr. S
Alarm/Remote Conhol
Swimming Pool � � ��
I he certi tfwt I ins Ihe elechical installation described herein on the
Irrigation Boom RagMn Dare
Special Inspectio —' 2' P'�
Final / /'��/
Investigative fee ( �r
THI$ INSTALLATION MAY BE ORDERED DISCONNECT'ED IF NOT COMP�ETED WITHIN 18 MONTHS.
- OFRCE USE ONLY This request void 18 months kom validafion date printed in this box.
111iillllllllllll I ��J� • �-�
II II III II I1I�1�� II III II III I�I
* � 4 � D 9 1 4 8* PLEASE PRINT OR TYPE
tequest Date Rou h-in i on uired$ Yes
g nspecfi req ❑ No Inspecfion Other Than RougMn: ❑ Ready Now �II Call
` a�� � 4 (You musf call the inspetior when ready) Dale Ready:
licensed contracror ❑ owner hereby request inspection of the above electrical work at:
ob Addreu �Sheet, Box, w Route No.) Ciry Zip Code
13�1 '
iection No. Township Name or No. Range No. Fire No. Counl�
Phone No.
mi{ictor (Comparry Name) Contrator ' se No. Master Lic. No. �Plant
�reu (Conhactor or Owner Performing Insfallalion� �
• �
$ignature �Conhac�w or Phone No.
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11 S/96 S7A� gOARD COPY - SEE 9�13TRUCTIONS ON BACK OF YELLOW COPY