P - 82828RE(�UEST FOR ELECTRICAL INSPECTION
r,f lJ O- 9 8 6 � Minnesota State Board of Electricity
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 remarks in this space and on the back of the white copy only.
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Calculate Inspeciion Fee - This Inspection Reques► will not be accepied withouf ihe correcf fee:
Other Fee # Servi e trance " e F e # Circuits/Feeders Fee
Mobile Home Pork Stall 0 0 200 mps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL r (-7�
Sign/Outline Ltg. Xfmr. �L/-Sr�t�_G�( �J •..2U
Alarm/Remote Control \
Swimming Pool
1 hereb certi that I ins ecled the eleckical installation described herein on the dates slated
Irri9ation Boom Rough-In Dare
Speciallnspecti - -
Final /
Investigative Fee `
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 M NTHS.
OFFICE USE ONLY This requesf wid 18 months from validafion date prinfed in fhis box.
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PLEASE PRINT OR TYPE
R��O Rough-in inspection required? ❑ Yes No Inspecrion Other Than Rough-In: eady Now ❑ Will Call
� (You musf call fhe inspedor when ready� Date Ready:
I, icensed controctor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route o.) Ciy Zip Code
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Section No. Township Name or o. Rang� � Fire No. C� �
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�i i� y i.o. , i� ii
�acfor (Company N e) � Conhactor License No. Master Lic. No. (Plant Elecl. Only)
�r� - �' �/.� ,-r�--�'",�lss�'
ss(Conhacfor or Owner Performiog Insfallafion) ��
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��naNre �Conh r or ner PerFo g Insfallati Phone No.
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8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY