P - 82755REQUEST FOR ELECTRICAL INSPECTION
���� p�� � Minnesota State Board of Electricity
0 1821 University Ave., Rm. S-128, St. Paui, MN 55104
Phone(612)642-0800
Fiome Duplex Apt. Bldg. Other: (I '�` New Addn
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Commercial Industrial Farm �'t d r's o52 w��r; Remod Re
Air Cond. Htg. Equip. Water litr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this jequest. Enier remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Requesi will not be accepted wiihout ihe correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generptor INSPECTOR'S USE ONLY TO,TArL�
Sign/Outline ltg. Xfmr. L.�7
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the elechical installation deacribed herein on the dates stated
Irrigation Boom Rnuah-In n...e
Investigative Fee '– `""r - .° �—
THIS INSTALLATION MAY BE ORDERED a1SC NNECTED IF NOT COMPLETED WIT IN 18 MOI�THS.
OFFICE USE ONLY This requesi void 18 months from validafion dafe prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Date .. . Rough-in inspecfion required? ❑ Yes �o lospeclion O�er Than RougMn
� S Q � �You must call the inspecror when ready� Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above eleclrical work at:
lob Address (Sheet, Box, or Route No.� Ciy
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Section No. Township Name or No.
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Power Suo er
tl rical Conh cto, (Compan ame� �
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Maili�� 9 Address �Contracror or Owner�� in8 Insfallationl,
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Aufhorized S' nafu (Conha for o Own ormin sfallafion)
8-000 -1 8/96 STATE BOARD PY - SEE II�
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�NS ON BACK OF YELLOW COPY
Now � Will Call
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