P - 806847�5-215 �
Home Duplex
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
i821 University Ave., Rm. S-128, St. Paui, MN 55104
Phone(612)642-0800
Other: New Addn
Commercial Industrial Farm Remod Re air
Air C Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of ihe whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without t e rrect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Pork 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 TOTA�„ ` C�
Sign/Outline Ltg. Xfmr. l%�CJ� J
Alarm/Remote Conhol
Swimmin9 Pool
I hereb certi ihat I ins the electrical installation described herein on the dates stafed
Irrigation 800m Rou9h-In oar�
Special Inspecti
Firwl
Investigative F —,27
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Reque Date/ .� Rough-in inspection required? ❑ Ves ❑ No Inspection Other Than RougFfln: Ready Now 0 Will Call
(You must call fhe inspector when ready) Date Ready:
1, licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Jo Address (Sheet, Box, or ute No.) Cj�-�—� Zip Code
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Secfion No. Township ame or No. Range No. Fire No. County /
� Occupant
2s,
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141
Phone No.
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COPY - SEE INSTRUCTpNS ON BACK OF