P - 83447REQUEST FOR ELECTRICAL INSPECTION �.
5�"�- 5 3 9 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �;
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: /� New ddn
Commercial Indushial Farm /' "� � Remod Re ir
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by Ihis request. Enter remarks in this space and on the back of fhe white copy only.
Calculate Inspecfion Fee - This Inspeciion Request will not be occepted wifhout the correct fee:
Olfier Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig_ Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL� c�
Sign/Oudine Ltg. Xfmr. v
Alarm/Remote Control
Swimming P
I h certi I►w1 I in the elechica) inslallation described herein on 1he dales slvlad
Irrigafion Boo R�„ p� l
Special Ins �i _�f/ '
Firal ' pc1e� � ,� n
Investigativ Sf3rob K�-x
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN MONTHS.
OFRCE U8E ONLY This requsst vad 18 months kan validation date printed in fhis box.
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* � 5 3 2 5 3 9 �{ �IC PLEASE PRINT OR TYPE
Request Date Rou hin ins fion r uiredi es
// T/� g pec eq ❑ No Inspecfion O�er Than RougMn: ❑ Ready Now ill Call
�'�8 (`/ou musT call the inspecfor when ready) � Dafe Ready:
I, ❑ licensed conhacror 8 owner hereby request inspeclion of 1he above electrical work aF.
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Seciion No. Township Name or No. Range No. Fire No. Counly
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Occupant � � Phone No.
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STATE BOMD COPY - SEE INS7RUCT10NS ON BACK OF YELLOW COPY