P - 80654REQUEST FOR ELECTRICAL INSPECTION �
7(� �� O Q Q � Minnesota State Board of Electricity
O J V 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New 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 remar in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park 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 oN�r TOTAL
Sign/Outline Ltg. XFmr. �• �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fhe electrical installation described herein on the dates stated
Irriqation Boom _ a„����,a� �are
Investigative Fee °
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPIETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesi Date Rough-in inspeclion required? ❑ Yes No Inspecfion Other Than Rough-In: ❑ Ready Now ill Call
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i, � licensed confractor ❑ owner hereby request inspection of the above electrical work ah
lob Address (Street, Box, or Rou�e No.� Ciy ����� Zip Code
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or No. Range No.
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Power Supplier Address
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Mailing Address o�rQS��pr�r��Pp�r�i�� Instalktion)
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Phone No.
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Conhactor License No. � Masler Lic.
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