P - 84633�4.4�8 �247
i
I �X° OI70V6
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 Hfr. Load Mgmt. Other:
Elec. Heat Temp. Service
reques►. Enter remarks in this space and on the back of the whiie copy only.
Calculate Inspection Fee - This Inspection Request will not be accc
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 to 00 Amps
Sfreet Ltg./Traffic Sig. Abo e 200 Am
Transformer/Generafor INSPECTOR'S USE ONLY
�ign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimmin Pool
wiihout the correct fee:
Fee # Circuits/Feeders
0 to 100 Amps
Above 100 Amp:
TOTAL
� %
9 I hereb certi fhat 1 ins ed fhe elechical installafion dexribed herein on the
Irrigation Boom RougMn ` a
Fee
Special lnspectio � =:-r—`— �`'�'' ���/ �7
Final i Date
Investigative Fee '^ ' O� 7 p%
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months 6om volidafion date printed in this box.
I II�I I) III II III II III II I�I II III ��1� II I�� II I �/��� %�
II I IIII ��
* 0 4 4 8 2 4 7 � �� �
7 PLEASE PRINT OR TYPE
Req �°�e Rough-in inspection required? Yes ❑ No Ins fion Other Than Rou Mn:
�_�_�� pec g ❑ Ready Now Will Call
(You must call the inspector when ready) Date Ready:
I, icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Shcet, , w Roule No.) Ciy • Zip Code
�� � �fi�n� �rseh �ne �r ac e
Seclion No. Township Name or No. Range No. Fire No. County �
�Kr9
���� Phone No.
Power Supplier
1`(S•
Eleclrical Conhacfor (Com ny
�Aaili�g Add � (C���
�• � I Contratlor license No. I Masfer Lic. No.
�„ �oiM.. � ww
..
,