P - 82988REQUEST FOR ELECTRICAL INSPECTIO���O �
��� P'° ��, 7� O � Minnesota State Board of Electricity
�� � 0 Y 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Seroice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculofe lnspec�ion fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps �I$,C�U 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR�s use oN�r TQT,
Sign/Oudine Ltg. Xfinr.
Alorm/Remote Control
Sy�imming Pooi
-- ft,e aerR Ifior I ins _ the electricaf inualkalion described herein oo N�e dok
Irriaati�n 800m :: - . • o�...k,., ... : m...:
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5. D.'�
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI7HIN i8 MONTHS.
_ __ _ - -- -- - -- — - - — - -- -- _ — __� _ —_� .��.�
OFFlCE USE ONLY This requesf void 18 months (rom validation date printed in this box.
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* O S 7(J � 2 8 Ia �K PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required? ❑ Yes No Inspeciion Olher Than Rough-In: Ready Now � Will Call
�� �� �You mus� call fhe inspecfar when ready� Date Ready: .
I,�licensed contractor o er her by request inspection of the obove electrical work at:
.bb Address (Skeet, Box, Ciy Zi Code
40 �:c��, ��
Secfion No. 7ownship Name or No. aru�e No. Fire No. nlv A
Occupant
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STATE BOARD COPY - SEE
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Phone No.
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onhactor License No. ° Master Lic. No. (Hant Elect. Only)
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SNS ON BACK OF YELLOW COPY