P - 827986.7.�=�05 �
REQUEST FOR ELECTRICAL INSPECTION
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
Commercial Industrial Farm Remoc
Air Cond Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy
.
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Calculate Inspection Fee - This Inspection Request will not be accepted wifhoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
TransFormer/Generator INSPECTOR'S USE ONLY TOTAL
iote Conhol
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Addn
Fee
Investigative Fee � � . �
THIS INSTALLATION MAY BE ORDERED DIS ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.._. OFFICE U8E ONLY This requesf void 18 months 6om validafion dafe printed in this box.
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PLEASE PRINT OR TYPE
Request Rough-in inspecfion required2 ❑ Yes No Inspecfion O�er Than Ro�l ❑ R
(`(ou musf call the inspector when ready) Date Ready: d
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job ress (S eet, Box, or RouTe �* Ci Zip Code
O � /Al.� S"�
Secfion No. wnship Name or No. ge No. Fire No. County
Power
• � Con�acFO�License No� �, � � Masfer Lic. No. (Plant
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Insfallahon) � •' ^ .. P
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY