P - 83231REQUEST FOR ELECTRICAL INSPECTION �..
5� C? =� 9 9 9 Minnesota State Board of Electricity -
1821 University Ave., Rm. S-128, St. Paul, MN 55104
'` Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. tg. Equ' . Water Hfr. Load Mgmt. Other:
ryer ange Elec. Heat Temp. Service
"X" above the work covered y this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepied without the correci fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall to 0 Amps � 0 ro 100 A
Sheet Ltg./TrafFic Sig. Above 200 Am s Above 100.
Transformer/Generator INSPECTOR'S USE ONLY 1 V I A �y'�
�C.J
Fee
Sign/Oudine Ltg. Xfmr. ✓
Alarm/Remote Conhol
Swimming Pool � ^2�"' �'�
I her ceAi Ihaf I ins the eleciri � inslallation described herein on Ih dates s ted
Irrigation Boom Ro„y�,.i„ po�
Speciallns 1+ � Z
Final Z� r �/
Investigative Fee r�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFHCE USE ONLY ihis requeaf wid 18 months from validafion dale printed in this box.
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* 0 5 6 6 9 9 9 9* PLEASE PRINT OR TYPE
R uesf fe � Rough-in inspection required$ es ❑ No Inspeclion Olher Than RougMn: ❑ Ready Now Will Cal�
(You musf call the inspecror when ready) Date Ready:
I, Gcensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, o�r Rq�e No.) . „ � Cily �• n n Zip Code
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� Mailing Address (Conhaclor or
Ronge No. � Fire No.
Phone No.
Conkacror
INC. CA00381
'., �G TN., k1N 55024
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Owner Perfy(�nirg Insiallation) 2 6� 2� . I Phone No.
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STATE BOARD COPY - SEE INSTRUCTIOWS ON BACK OF YELLOW COPY