P - 80995REQUEST FOR ELECTRICAL INSPECTION
C�-� �� 3 2 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 Industrial Farm Remod )C Re air
Air Co� Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ►his request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Requesi will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps 8
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY �TAL ��
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol ��S O
Swimming Pool
I hereb cerfi thaf I ins the elechical insfallafion described herein on the daMs sfated
Irrigation Boom Ra„y�, �„ Dare
$pecial Inspecti r" � •
Final . Date� g_^�
Investigative Fee ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT C0IAPLETED WITHIN 18 MONTHS.
. OFFICE I�E dNLY This requesf vc+id 18 months from validation date printed in this box.
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� PLEASE PRINT OR TYPE
Request Date Rou h-in ins ection r uired?
g p eq ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
9�� (S (You must call the inspector when ready� Dafe Ready:
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I, �licensed conhactor ❑ owner hereby request inspection of the above elecfrical work at:
1ob Address (Sfreef, Box, or Route No.) � City Zip Code
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Section o. Township Name or No. Range No. Fire No. County
O/c�cupant I Phone No.
I�C/�rJi1_e�TN. �� 1�}4w�1� � AGLITC f w�"/ �
ny Name) Contractor License No. Master Lic. No.
� � C � , C�hc�C�b�
or Owner Performing Installatio �
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ictor or ner PerForming Insfa lafion Phone No.
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STATE BOARD COPY - SEE INS N BACK OF YEJI. LOW COPY