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REQUEST FOR ELECTRICAL INSPECTION �'�
Minnesota State 8oard of Electriciry �-, �
1821 Universiry Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800
Other: ' New Addn
Water Hh. Load Mgmi. Other: �
Elec. Heaf Temp. Service
requesf. Enter remarks in fhis spoce and an the back of �he white copy only.
�ol� C�(�L`�i1 �QS(=1?�-���5
;fion Reques� will no1 be omepfed without lhe correct fee:
k Service Enhance Size Fee # Circuits/Feeders Fee
0 to 200 Amps � 0 to 100 Amps
Above 200_Amps Above 100_Amps
INSPECTOH'S USE ONLY TOTAL . . _
Alorm/Remote Confrol
Swimming Pool
I here6 certi �hm I ins ned ihe elearicol insmllaNO� descri6ed herein on rhe dates siated
Irrigation Boom. ea,9ha� �a
Speciallnspec � ^
Investigotive Fee � F��� � �„
Tl11S INSTALLATION MAY BE ORDERED DI ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This raquesr void 18 monikrs fmm validation date prinMd in this box.
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LEASE PRINT OR TYPE
Requexr a�e Rougl�ln inspenion requlred? ❑ Yas No Inspecfion O�her ihon Rougbin: ❑ Reody Now III Call
� I�oo must mll ihe Inspecror when ready� Do1e Reody:
I, li<ensed conlmctor ❑ owner hereby requesf inspection of the above eledrical work a}:
b6 Addreu (Sheel, B w or Rwre No.� Cly Zip Gade
I a2b d-� a�� �r� I Q,u 5�3 2
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nvonor�Company Nome�
BIAINE HTG. A;C ELECT., WC.
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, ANQI(A, N 55344
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STATE BOARU COPY - SEE INSTRUCTIONS ON BACK OF VELLOW COPY