P - 84636REQUEST FOR ELECTRICAL INSPECTION - _
'-F `F�� — 2 4 4 Minnesota State Board of Electricity
/ 1821 Uni��ersity Ave., Rm. S-12S, St. Paul, MN 55104
Phone(612)642-0800
Home
Commercial
„X„ above the work covered
Farm
Water Hfr. Load Mgmt. Other:
Elec. Heaf Temp. Service
request. Enter remarks in this space and on Fhe
New
Remod
copy
Calculate Inspection Fee - This Inspeciion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to Amps 0 to 100 Amps
Street Ltg./Traffic Siq. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTJ4L
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Conhol ��
Swimming Pool �' � c
I here certi that I ins ted the elechical insfallation dexribed herein on the e»t dZ—
Irrigation Boom RayM� � Date �
Special Inspectio ( � -rr- 9
Final Date^ — 9
Investigative Fee �-r l
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 this box.
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I, icensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sheet, Box or Route No.� Ci1y • Zip Code
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