P - 82489��-�-232 �
Commercial
Air Cond.
Dryer
"X" above the �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-08 0
Apt. Bldg. Other: f� r�p N
Farm l � Jh'�� Re
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
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request. Enter remarks in this space and on the back oF the white copy only.
Calculaie Inspection Fee - This Inspection Request will not be accepled withov► ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT,
Sipn/Outline Ltq. Xfmr.
Fee
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Jwimming f'odr/ (� I hereb certi that I in: ted the elechical installation described herein on tl�e dates sfated
Irrigation Boom Rough-In Dar�
Special Inspection y�G— �
Investigative Fee �� �G�- !%LC�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED {F NOT COMALETED WlTfil 1$ ONTNS.
OFFICE USE ONLY This request void 18 moMhs from validation date pri�ted in this box.
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P ASE PRINT OR TYPE
Request Date Rough-in inspeclion required? ❑ Yes No Inspecfion Olher Than RougMn: ❑ Ready Now i0 Ca0 .
D.— G...�Q (You must call the inspector when ready) Date Ready:
I, ❑ licensed confractor owner hereby request inspection of the above elecfrical work at:
lob Addreu �SheeT, Box, or Route No.) Ciry Zip Code
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or No. � � Range No. � Fire
Occupant
Power Su�
Electrical Contmcfor (Company Name)
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Mailing Address (Co�hactor or Ownar
or
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. No.
Phone No.
'�"> > 8�9 ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY