P - 83395REGIUEST FOR ELECTRICAL INSPECTION -�
5 C J � C] (� h Minnesota State Board of Electriciry
�� J J�� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commerciql Industrial Farm Remod Re ir
Air Cond. Htg. E uip. Water Hh_ Load Mgmt. Other:
ry r� an Elec. Heat Temp. Service
"X" obove the work covere y this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspeciion Fee - This Inspection Request will not be accepled without the correct fee:
Other Fee # Service Entrance S' e Fee # Circuits/Feeders Fee
Mobile Home Park $tall to 00 Amp 0 to 100 Amps
Street Ltg./Traffic Sig. Abo e 200 Amps Above 100 Amps
Transformer/Generator INSVECTOR•s use oN�r TOTAL� �\
Sign/Outline Ltg. Xfinr. U
Ala�m/Remote Control
Swimming Pool
I here certi that I in the eleclrical installation described herein on Ihe da�es sla�ed
Irrigation Boom Roogh-In `� Date ��q
Speciallnspecti ~3 7
Final Del�i �
lnvestigative Fee /'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ OFRCE USE ONLT This requssT vad 18 months from volidafion date prinled in this box.
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* � 5 Ea 6 9 9 5 7* PLEASE PRINT OR TYPE
Request re Rou h-in ins fion r ired$ es
� � g pec eqn ❑ No Inspeclion Olher Than RougMn: ❑ Ready Now ill Call
� I (You musf call the inspector when ready) Date Ready: �
I, licensed conhactor ❑ owner hereby request inspection of the above elecfrical work at:
Job Ad�s (Sneet, Box, or Rou No.� C� Zip Code
Seclion No. Township Name w No. �. Range No: Fire No. Counivr� _
CR�ES
Phone No,
license No. I Masler lic. No. (PI
''�'"%�Y MN 550?.4
��"+-38f 0
v �
STATE BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY
No.