P - 81463REGIUEST FOR ELECTRICAL INSPECTION
5��- 9 5 2 Minnesota State Board of Electricity
a 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ihe back of the white copy
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Cakulaie Inspection Fee - This Inspeciion Request will not be accepted without ihe correci 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 Am s Above 100 Am
Transformer/Generator INSPECTOR�s usE ON�v TOTA
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conirol
Swimminq Pool
Fee
5. �'
Special Inspec�n'� ' � �� N
Investigative Fee �~ � Z '7�- mc'�
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months 6om validaficn dote printed in this box.
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* 0 5 1 8 9 5 2�# PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes
❑ No Inspecfion O�er Than Rough-In: ❑ Ready Now 0 Will Call
�You must call the inspecfor when ready� Dafe Ready:
I,�ficensed conhactor ❑ owner hereby request inspection of the above elechical work at:
lob Address �Sheet, Box, or Roufe No.J Ciy Zi Code
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Section No.
Occupant
Power Suoo
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1 8/96
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Range No. fi�e No. Couny
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Phone�� �� � �
Addre
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Conhaclor License No. Master Lic. No. (PYanl
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��n Insfallafion
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formi Installalion '
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