P - 82805REGIUEST FOR ELECTRICAL INSPECTION
6�O^ '� �/1 Minnesota State Board of Electricity -
« �f 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '��
Home Duplex _ Apt. Bldg. Other: New Addn
Commercia) Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. En►er remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Reqvest will not be accepted wifhout the correct fee: .
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall O to 200 Amps 0 to 100 Amps
Sfreet Lfg./Traffic Sig. Above 200 Am s Above 100 Amp:
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the eleclrical installation dexribed herein on the da
Irrigation Boom eo�aM� o�
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Investigotive Fee ( D
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 lNONTHS.
OFFICE USE ONLY This requesf void 18 monihs from validation date printed in fhis box.
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PLEASE PRINT OR TYPE �f
Request Date Rough-in inspection required$ ❑ Yes o Inspeclion OIF�er Than Rough-In: y Now 0 Will Call
(You must call the inspeclor when reody� Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address Sheet, Box, w Route No.) �^� Zip Code
�� ,� C� O�CiG�ns �F- � r� l e y �S�s- y-� �
Seclion No. ownship Nome or
Occupant
Power Supplier
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Elechi Conhaclor (Company Ni
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Mailing Address (Conkac�or w O�
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No. Masfer Lic. No. (Planf Elecf. Only)
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Phone No.`.,_ _ „� �
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY