P - 82925RE(�UEST FOR ELECTRICAL INSPECTION � -�-�..
5 U e� � J J o Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
' Phone (612) 642-0800 '
Y Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Ntg. Equip. Water Hh. oad Mgmi. Olher:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of Fhe white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied wifhovt the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 ro 100 Amps
Sfreef Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT/�L _�;�
Alarm/Remote Control
Swimming Pool
I here certi that I in the electricol installafion described herein on the dales stmed
Irrigation Boom Ro�Mn D�
Special Inspectio
final
Investigative Fee � ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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* � 5 6 6 9 9 � 8* pLEASE PRINT OR TYPE
R���� �+% Rough-in inspeclion required$ Yes �� No Inspeclion Other Than RougMn: dy
`^,C � ❑ Rea Now Will Call
V(`(ou musi call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or o.) Ciy �� Zip Code
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ca�—l.J
Seclion No. Township Name a No. Range No. Fire No. Cou�� �
Conhacfor
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Phone No.
Conhacfor License No. I Masfer lic. No.
(ConfracFOr or Owner �eiioiming InsfallaKon� ���
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY