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RE�UEST 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 Remod Re ir
Water Hh. Load Mgmt. Other:
Elec. Heat Temp. $ervice
this request. Enter remarks in ihis space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Requesi will not be accepted without the correct fee:
Other Fee # Service Entran e Size Fee # Circuits/Feed�
Mobile Home Park Stall 0 to 00 Am ! 0 to 100 Amps
Street Ltg./Traffic Siq. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY TC
Sign/Oudine Lig. Xfmr.
Alarm/Remote Control
Swimming Pool
I he�eb certi that I ins ted the elec ' ol installation described herein on the <
Irrigation Boom R M '
Fee
oug n � Da ` � L. �
$pecial Inspecti �'
Final
Invesfigative F < . r- � r2
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation date printed in fhis box.
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* � 4 4 8 2 3 6 �* PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required2 ❑ Yes
�� ❑ No Inspection O�er Than RougMn: ❑ Ready Now ❑ Will Call
(You musf call the inspector when ready� Date Ready:
I, icensed conhactor ❑ owner hereby request inspection of the above elechical work at:
Job Address �Sheef, Box, or Route No.J City • Zi Code
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Secfion No. Towns ip Name or No. Range No. Fire No. Counly �
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n��i�� ndd.� �co «ro� a o�
AWfwrized Sipna re (Conkaclor
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Phone No.
Conhar,for License No.
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