P - 84598�48-�42
Home Duplex
Commercial Indushi
Air Cond. Htg. Ec
Dryer Range
"X" above ihe work covered
REGIUEST 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 Htr. L Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remorks in fhis space and on the back of �he while copy only.
Calculate Inspeciion Fee - This Inspection Request will not be accepted wi�hout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. �S
Alarm/Remote Conhol
$wimming Pool
i hereb certi fhaf I in ed the elecfrical installafion described herein on the dates sfated
Irri9ation Boom RougMn pa�
Special Inspectio
Final pa ^` �
Investigative Fee 2Q,
THIS INSTALLATION MAY BE ORDERED DISC CTED �F NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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Requesf Date Rou h-in ins
/ g pection required$ es ❑ No Inspecfion Other Than RovgMn: ❑ Ready Now Will Call
�� � 7 (You must call the inspector when ready) Date Reody:
I, ' ensed conhactor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sheet, � or Roufe Nq) C��y Z�P C�
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Section No. Township Name or No. Range No. Fire No. Coun
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��� rh� No.
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Elechical acfor LCom n Name) Conhactor Licenze No. Master Lic. No.
ES ELEP°C�RIC, INC. CA00381
s�oc-��r� �
Mailirg Addreu �Conhacbr or Owner Pe�ii� I ation)
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Authori ignoture (C aclo rming In la' � Phone No.
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E&00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY