P - 82386REQUEST FOR ELECTRICAL INSPECTION
8����� � � Minnesota State Board of Electricity �
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
° Phone (612) 642-0800 `��
Home Duplex Apt. Bldg. Other: Addn
Commercial Industrial Farm Remod Re air
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 white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Tra$ic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�v �D TOT /�
Sign/Outline Ltg. Xfmr. e
Alarm/Remote Control � g 3 �
Swimming Pool
I hereb certi thaf I in elecirical installafion deuribed herein on the dates sfated
Irrigation Boom RougMn Da
Speciallnspection � �'�'
Final Da
Investigative Fee 0^ � p
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�" �5� � OFFICE USE ONLY This request void 18 monfhs from validation date printed in fhis box.
I III� II III II II) II III II III II II�I) III II III I IIII ��O �
* 0 8 0 2 2 2 1 2* �/ J,�
PLEASE PRINT OR TYPE
Requesi J� Rough-in inspeclion required$ Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call �
° '^ D(,J �You musf call the inspecfor when ready) Dafe Ready:
I, ❑ licensed contractor �owner hereby request inspection of the above electrical work at:
lob Address �Sfrcet, Box, or Route o.� Ciy Zip Code
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Secfion No. Towns ip e or N Ran e No Fire No. Coun �
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Oc pant , Phone No.
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Powe� Su pli �O Add s
,I%Q.� � � 1 c �t �n0 �
Confmctor
Mailing Tddress �CEnhacfor or Owner Performing Installafion�
or
Conhatlor
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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