P - 8297959�-495 ��
Commerc
Air Cond
Dryer
"X" above th�
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: ��/n /� New Addn
Farm �r// (�1 C- � Remod Re air
Water Hfr. Load Mgmt. Other:
Elec. Heat Temp. Service
request Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspec�ion Request will not be accepfed wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Ar
Transformer/Generaror INSPECTOR'S USE ONLY TOT�
Sign/Oudine Ltg. XFmr.
Alarm/Remote Confrol
Swimming Pool
/ I here ' ihat I in the eledrical installafion described herein on the doh
Irrigation Boom Ro�,oMo D�e
Fee
THIS INSTALLATION MAY BE ORDERED DISL�NNECTED IF NOT COMPLETED WITHIN 18 MONTFIS.
O� I�E ONI.Y This roquest void 1 s kom validation date prinfed in this box.
� IIII (I I�) �I �II I) �I) I) II� I) �I� I� ��) �� ��� - - �� 7�
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* 0 5 9 % 4 9 5 ]r �K PLEASE PRINT OR TYPE
Request DaN� RougfFin inspection required? .❑ Yes Inspecfion Other Than RougMn: eady Now ❑�II Call
f �`/ou mosf call the inspecior when ready) Da�e Reody:
I, 'censed c hactor ❑ owner hereby request inspection of the a6ove elechical work at:
Job Add ss (Sheet, Box, or Route No.) . ily Zi ���
' �
Seclion No. Township ame or No. Range No. Fire No. Counly .
Occupan/'� /��� Phon � Ng yf� ` ��� .
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�Confractor or
�4L
A-11 8/9
3/l � �55 � ���z�. �°�e
` �,.,�,� com.a�ro� ���� 5r�.
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>��� i�r�nah ^� /
/ % � �/p`/�' i
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ner Performi�g Ins 'on) � Phone �
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TE BOARD COPY - SEE INSTRl1CT10NS ON BACK OF YELLOW COPY