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REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electriciry
1821 University Ave., Rm. 5-128, St. Paul, MN 55104
Phone(612)642-0800 "�'
Other: New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on
Remod
the white copy only.
Calculate Inspection Fee - This Inspeciion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Amps Above 100 Amp:
Transformer/Generator INSPECTOR�s use oN�r TOCTAL
Sign/Oudine Ltg. Xfmr. �
Alarm/Remote Confrol
Swimming Pool
1 hereb certi thaf I ins fed the electrical installation described herein on fhe dates s�
Irriaation Boom e,,,,,,�.i., Dare
Fee
nnoi
Investigative Fee � � r. " -f ' — — � - Z �`–
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THIS INSTALLATION MAY BE ORDERED DISC TED IF NOT COMPLETED WITHIN 18 MONT S.
OFFICE USE ONLY This requesf void 18 monfhs from validafion dafe prinfed in this box.
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7k � 4 9 8 9 6 8 7�k LEASE PRINT OR TYPE `���' ��
Request Dafe Rough-in inspection required? es ❑ No Inspection O�er Than RougMn: ❑ Ready Now ill Call
G`�- �--� �� (You must call the inspector when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box or Route No.) City Zip Code
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Section No. Township Name or No. Range No. Fire No. County �� ����,j
Power Supplier /J
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el�r.��al co�q�`�����i`�� INC.
310G-2257H oT. W., FG �
Mailing Address (�hacror or O�yner Perf �
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or
Phone No.
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Address
Contrador License No. Masfer Lic. No. (Plant Elxt. Only�
CA00381
!N 55024
tion)
;mllafionl _ A A Phone No.
1 A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY