P - 83233� REQUEST FOR ELECTRICAL INSPECTION �
5 6 6- 9 9 4 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 Indushial Farm Remod Re ir
Air Cond. Htg.,Equip. Water Htr. Load Mgmt. Other:
rye Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of ►he white copy only.
Calculate Inspeciion Fee - This Inspection Request will nof be accepted wilhout the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 00 Amps 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT x
Sign/Outline Ltg. Xfmr. � � �/ � �
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the elechical " slallafion described herein on the dares staled
Irrigation Boom eo�Mo — Da�
Special Inspecti ^ ��_ �
final
Imestigative Fee — '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH N 18 MONTHS.
OFFICE USE ONLY This request vad 18 months 6om validafion da�e printed in this box.
III III(� � 75�
(I�IIII�I�IIIIII�IIIII (I�IIIII���III� ��3
y
* � 5(a 6 9 9 4 0 * PLEASE PRINT OR TYPE
R�1y�T �� � Rough-in inspeclion required$� es ❑ No Inspecfion OFher Than RougMn: ❑ Ready Now Will Call
l� (You must call the inspeclor when ready) Date Ready:
I, licensed conhacror ❑ owner hereby request inspection of the above electrical work at:
J�ress'$�f, Box, or Routa�No.) � Zip Code
��Or
'( p '
Power
� Mailing
Name or No. � Range
PAone No.
i'll9'I�. °@LE .C)TRIC, INC. CA003�4o�TMa��r ��cense
310C-22�Tii ST. W., rG TIV., k!N 550
or Owner Pertorming(r{sfallation� . .� n^�t� I p
� O�
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY