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ICalculate InspeUion Fee - Tfiis Inspc
O[her Fee
REQUEST FOR ELECTRICAL INSPECTION `� '��:
Minnesota State Board of Electricity ���k
1821 UniversiTy Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �'-
Apt. Bldg. Other'.� D � New X Addn
Farm �I� Remod Re air
Water Htr. Load Mgmt. Qlher:
Elec. Heat Temp. Service
requesG ENer remorks in fhis space and on �he back o{ the whife copy only.
will no� be acce
z Enhance Size
without the correch fee:
Circuits
Oto 100A
Above 100
Transformer/Generotor INSPECTOR'S USE ONLY TOT/yL /' c7�
/� d�
Sign/Oulline Ltg. Xfmr. W �
A�arm/Remote Conlml � ( /qq — �� � ' ° Sy-�
$wimmin9 Pool I he�eb cen� tho� I ins ened ihe elendml ��smllm�a,'tl'e�� Ikre�� o� i d-a'ks �6ied �� J
Irrigotion Boom eo�gh-i� ooig� ,.��j'
Spetial lnspection � ! Z"'�" ��
Finol oot
Investigolive Fee � //2 ���
THIS INSTALLATION MAY BE ORDERED DISCON ECTED IF NOT COMPLETED WITHIN 78 MONTHS.
OFFICE USF ONLV ihis reqoesl void�y momhs hom validolion dme prinled In ihis box.
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0 8 0 2 3 7 2 3� K'' "
PLEASE PRINT OR TYPE �7s�
Reques� Da Rough-in inspecFon requlred? Ye: ❑ No Inspenion Oiher Than Roogh In: ❑ Ready Now Will Coll
�� �� bZ (Yoo mos� call �he Inspecior w n r dy� Do�e Reody:
I, ❑ licensed confroclor � ownet hereby request inspection of Ihe above electrical work al:
lob Address (Slreet, Box, or Ro��e No � Ciy Zip Code
�[� RLI �'r�c�l r.� S-F� ��^�'� �ev Ss5/3�
763 s7Y -ot9s
� n� ���
ss �COnim<tor or uwner rertorming Insmllmion�
4 FFi^1` Q � i 4 .�"�%Lt'� �/� I
STATE BOAIiD COPV - SEE INSiNUCT10N5 ON BACK OF YELLOW COPY
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