P - 82808�
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� � REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Commercial indushial Farm �' ""' "``" Remod
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other: � l(%�
Dryer Range Elec. Heat Temp. Service � 5�;, .,s
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy
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Calculate Inspecfion Fee - This Inspection Reqvest will not be accepted wifhout fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�r TOTAL
Sign/Oudine Ltg. Xfmr. �/ �
Alarm/Remote Confrol
Swimming Pool
I here cerfi ihat I in the electriml insfallation described herein on the dales stafed
Irrigation Boom RougM� -
Special Inspect
Final �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE 1�E q11.Y This requesf wid 18 months from validation dare printed in this box.
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* � 5 3 2 5 1 5 4� PLEASE PRINT OR TYPE
R89�� � Rough-in inspeclion required? �Yes �❑ No Inspecfion Other Than Rouglrin: ❑ Ready Now Will Call
'� + 7 �� 8' (You must call the inspecror when ready) Date Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
lob Addreu (Shcet, Box, w Route No.) Ciy Zip Code
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Seclion No. Township Nome or No. Range No. Fire No. Couny �
30
occopaor
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Contractor
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�Conhactor or Owner Perfwming
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STATE
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Conlractor License No. Master Lic. No. IPIc
��°��� 2634 8 � s7a �o ys
COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY