P - 84570�4.��235
Home Duplex
Commercial Indushi
"X" above
REGIUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: ew Addn �
Farm
Water Hfr. Load Mgmt. Other:
Elec. Heaf Temp. Service
request. Enter remarks in this space and on
copy only.
Calculate Inspection Fee - This Inspection Reqvest will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 0 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOH'S USE ONLY T�TAL
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control /�� S
Swimming Pool �
1 hereb certi ihat I ins ed the eleclrical insfallation dexribed herein on the dates sfated
Irrigation Boom Rougffln pa�
Special Inspection ti �`— �' ��- 7
Final
Investigafive Fee �-� — ���'–u � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monrhs (rom validafion date prinfed in Ihis box.
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P RINT OR TYPE
Request Dafe Rougltin inspecfion required? es ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now Will Call
� �. (You must call the inspector when ready� Dafe Ready:
I, icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or RoWe Nq,� Ciy � Zip Code
� �S� �p L e
Secfion No. Township Name or No. Range No. fire No. County
A-n1 o f�
Occu nf Phone No.
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�� c�°'�9�4t��6G*�PMC� INC. CA00381
310G-225Tii 3T. W.. FGTN., MN 55024
Address {[onkactor or OwOer Per(oon�na Ins1a lahonl
ignarure ��onrcacror or
1 S/96
nnasre.