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Dryer Range
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RE�UEST 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: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. $ervice
request. Enter remarks in �his space and on Ihe back of the white copy only.
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Calculate Inspection F�e - This Inspection Request will not be accepfed without the correct fee: �
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Other Fee # Service Entrance Size Fee # Circuits/feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer�Generator INSPECTOR'S USE ONLY TOT �SD
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conirol
Swimming Pool
I hereb certi fhaf I ins fed the elecfrical insfallafion described herein on the datzs stated
Irrigation Boom Rough-In pa�
Investigative F� U -L t7 ...�. ,��,c� --� "°��� — `� 7
lTHIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation dafe prinfed in ihis box.
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* � 4 7 4 5 3 3 7* PLEASE PRINT OR TYPE �
Request Date Rough-in inspection required? ❑ Yes ❑ No Inspecfion 01her Than Rough-In: Ready Now 0 Will Call
�/ (You must call the inspector when ready) Dafe Ready:
I, ❑ licensed conhactor ❑ o r reb r e' f he above elechical work at:
Job Addweu �Streef, Box, or Roufe No.) . _ �' y� � CiN . � I Zip Code
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Section No. I Township Na�or No. I Range No.
I Power
ny Name�
J.�i
or Owner Pe
ctor�
Phone No.
License No.
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B ARD COPY - SEE INSTRUCTIONS ON BACK OF YEI
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