P - 79448REQUEST FOW ELECTRICAL INSPECTION ��"' ��r.�
�(� rj ���g 4� Minnesota State Board of Electricity "�
U L 1821 University Ave"�., m. S-128, St. Paul, MN 55104 ��.�
Phone (612) 642-O�v n �/� �'�
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�ome vupiez r�Ni. oi�y. ..i„�'. / V.. S� .L�/
Commercial Indushial Farm Remoc
Air Cond. Hlg. Equip. Water HM. Load Mgmt. O�her
Dry Range Elx Heaf Temp. $ervice
� above the work rovered by fhis �equest Enfer rema�ks in this space and on the back of fhe whrte mpy
Calculale Inspection Fee - 7his Inspecfion Reques� will r�o� bee accepfed withou� the mrrect fee:
Other Fee # Service Entrance Size Fee # Circuifs/Feeders Fee
Mobile Home Park Smll 0 to 200 Amps 0 fo 100 Amps
Slreet Lig./Traffic Sig. Above 200_Amps Above 100_Amps
Transformer/Generoror MSPECTOF'S USE ONLV TOTAL�/ �T
Sign/Oudine Ltg. Xfmr. �/�C�� �U,� �� Q� ��
Alorm/Remote Conhol � � �� ��
$Wimmirtg Pool I hereb cen� �har I �� cied the elecrciml Insmllm�o� descrbed herein o� the dmes smted
Irrigolion Boom Roughl� s27 �a
Special Inspecfion F, al oo �
Investigafive Fee — �� U �
THIS INSTALLATION MAY BE OflDEREO DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
` OFFICE USE ONLY This requesf roid 18 mon�hs from vafidafion date prinfed in Ihls bax.
I lul I� III II II I I�) II III � I I I I II I I II II I I�
* 0 8 0 2 2 9 4 4 x ����,� �/. � O
PLEASE PRINT OR TYPE
Requex� Do�e Rougbin inspection required2 ❑ yes ❑ No Inspecfian Other 1}ian Rough�ln: ❑ Ready Now � Will Call
' 6 I �You mon call �he inspeclor when reody� Oale Ready:
I, licensed contracYOr � owner hereby re��]i!¢�ay�of the dbove eledrical work at
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