P - 81021�
�27-032 �
Home Duplex
Commercial Industrial
Air Cond. Ntg. EqJ
Dryer Range
"X" above the work covered b
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �.
Phone (612) 642-0800 `��'
Apt. Bldg. Other: ,}���! r� � New Addn
Farm L/ �t �� Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. EnFer remarks in this space and on the back of ihe white copy only.
Calculate Inspection 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 �0 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONtY TOT,
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Fee
I hereb cerfi that I ins ted the electrical installafion dexribed herein on the dafes sfated
Irrigation Boom Rough-In Dare
Special Inspe
F�pl Date� 2.kgZOei
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF MOT COMPLETED WITIi1N 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
Illll�lilllllllll������I�R����I��I� • �a-�
* 0 8 2 7 0 3 2 4* ��(��
PLEASE PRINT OR TYPE
Request Qafe Rough-in inspection required? ❑ Yes o Inspeclion Olher Thon Rough-In: eady Now �� Wil! Call
� a �3 �� (You must call the inspector when ready� Date Ready:
I, icensed contractor ❑ owner hereby re uest inspection of the above elecfrical work at:
Jo. Add ss (S eef Bo or R No.� �� � Ciy Zip ,/��
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Secfion . ownship Name or o. Range No. Fire No. Counly n n ��
� Occupant
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Owner Perfc+rminq Inslallotic
Phone� ^ ` / �
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Conhacfor Licensa No.
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BOARD COPV - SEE iNSTRUCTIONS ON BACK OF YELLOW COPY
Lit. No.