P - 82895RE(�UEST FOR ELECTRICAL INSPECTION -_
5� V- 712 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: �(' �� New Addn
Commercial Industria{ Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied withoui fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator i� � pr�'S uSE/�� � TOTAI�
Sign/Outline Ltg. Xfmr. G� � (,� - '
Alarm/Remote Conhol ''l�� ( , � • S Q
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Swimming Pool I here6vi ceAiH thaf I insoecled the electrical insfallafion described herein on the daAes sialed _
investigative Fee " �b��1
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI IN 18 MONTHS.
OFFICE I�E ONLY This requesf vad 18 months from validation date prinfed in this box.
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* O S 8 8� L 2 O* PLEASE PRINT OR TYPE
Request Dafe Rougltin inspeclion required? Yes ❑ No Inspeclion O�er Than RougMn: Ready Now ❑ Will Call
���3"� (You musf cali �he inspecbr w n ready) Date Ready:
I, � licensed confractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address �Sfreef, x, w Route No.) City� Zip Co�d—e-�/
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Seclion No. Township Name w Range No. Fire No. Couny
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I Power
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Phone No.
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License No. Master lic. No.
�$�9 � ST BOARD COPY - SEE INSTRUCTONS ON BACK OF YELLOW COPY