P - 83400RE(�UEST FOR ELECTRICAL INSPECTION Y
v�'� �- 9 9 7 Minnesota State Board of Etectriciry
y; m 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. . Equip. Water Hfr. Load Mgmt. Other:
Dryer Range � Elec. Heat Temp. $ervice
'X" above the work covered y this request. Enter remarks in this space and on the back of the whiie copy only.
� Calculate Inspection Fee - This Inspection Request will nof be accepted without the correct fee:
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Other Fee # 5ervice Entrance Size Fee # Circuits/feeders Fee
Mobile Home Park Stall 00 Amps " 0 to 100 Amps
Street Ltg./Traffic Sig. Abo e 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL� ��
Sign/Outline Ltg. Xfmr. �� f � `
Alarm/Remote Control
Swimming Pool �� �em that � in e electrical installafion deuribed herein on the dates staled
{rrigation 800m RougMn _ _� �
Special Inspection �
Final — T�
Investigative Fee " -
THIS INSTALLATION MAY BE ORDERED DISCONN TED IF NOT COMPLETED WITHIN 18 MONTHS.
__--�� ...� —
OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
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III�) II��� II II) III�) II �I IIIII I�III
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PLEASE PRINT OR TYPE
�uest Date Rough-in inspec6on required$ Yes ❑ No Inspecfion Olhe� Than RougMn: ❑ Ready Now Will Cbll
.Q ( � 3 (You must call the inspector when ready) �rte Ready:
licensed contractor ❑ owner hereby request inspection oF the above electrical work at:
� Power
Name or No.
�&R�dhpl MN 55024
463-3810
Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY