P - 84627REf�UEST FOR ELECTRICAL INSPECTION =� �
�'t ��-18 6� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bidq. Other: New Addn
Commercial Indusfrial Farm
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by Ihis request. Enter remarks in this space and on the
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copy
Calculote Inspection Fee - This Inspeciion si wiU nr�' �-ec�epted without fhe correct fee:
Other Fee # Service Entrence Size Fee # Circuits/Fee�prs %.t
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generotor INSPECTOR'S USE ONLY TOTAL�D �
Sign/Oudine Ltg. Xfmr. "�
Alarm/Remote Conhol
Swimming Pool
I hereb cerfi thaf I ins fhe electrical installafion deuribed herein on the dates sfaled
Irrigation Boom Ro„ �„ pa
Special Inspecti 9 '� ��' � � �
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Investigative Fee t-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 madhs From validafion date prinfed in this box.
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Requesf Dafe � Rough-in inspecfion required$ es ❑ No Inspecfion Other Than RougMn: ❑ Ready N ill Call
6'���O�g (`/ou must call the inspector when ready) Dafe Ready:
I, �ensed conhactor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Skeet, Box, or Rou1e No.� Cil� n� Zip Code
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$ection No. Township Name or No. Range
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or Owner Performing InsMllalion)
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