P - 82696, REQUEST FOR ELECTRICAL INSPECTION —_
4,1.? �- 9.12 Minnesota State Board of Electricity
1821 University Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800
ome Duplex Apt. Bldg. Other: New Addn
Co ercial Indus ial Farm Remod Re air
ir Cond. ' g. Equip. Water Hfr. Load Mgmt. Other:
ryer �` ang Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted wifhout fi�e correcl (ee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to Am 0 to 100 Amps
Street Ltg./Traffic Sig. Abo e 200 Am s Above 100 Amps
Transformer/Generator �NSPECroe'S USE ONLY TOT�.�
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control � C, �
Swimming Pool
I certi Ihaf I ins Ihe elechical installaKon deuribed herein on the dares stated
Irrigation Boom •��: .i RougMn �^-� ooa�
°- _� �_ --� - . ( `'- � 5—/�Z�%
Imestigative fee
THIS INSTALLATION MAY BE ORDEF�D D IF NOT COMPLETED WITHI 18 MONTHS.
� OFHCE USE ONLY This request void 18 months from validafion date printed in this box.
_ ��_� � �
1 IIII II III II III II III II III II I II III II III I III�
* O 4 O C) 9 L G� G� * PRINT OR TYPE
Request Rough-in inspection required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑�II Call
� �You musf call the inspecfor when ready) Date Ready:
I, ' nsed contractor ❑ owner hereby request i�spection of the above electrical work at:
Job Address (Skeef, Box, or Roufe No.) Ci Zip Code
ao� C. ►2�s� �`��
Secfion No. Township Name or No. Range No. Fire No. . Coun � .
� lli4:�
Phone No.
L"kense No. �� MasAar lic. No.
SignaNre c r or er PerfoFmin 'Installotion�% I P
.r t� � �
�1 1 8/96 � STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY