P - 8327267.�=3�5 �
Home Duplex
Commercial Industri
Air Con Htg. Ec
Dryer Range
"X" above the work coverea
Calculafe Inspection Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Tra n sformer/Generator
Sign/Outline Ltg. Xhnr.
Alarm/Remote Control
Swimming Pool
Irriqation Boom
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Other. New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enfer remarks in this space and on
copy
�
�
.;�i
Addn
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>n Request will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits/Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100 Amps
INSPEC70R'S USE ONLY TOTAL _ �
I herebvi certiH that I
rhe
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 1 S months from validafion dafe prinfed in this box.
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I III II III II �I II � I I�I
* 0 6 7 4 3 8 5 0* (�5�9
PLEASE PRINT OR TYPE
.Request le Rough-in inspection required? ❑ Yes No Inspection Ofher Than Rough-In: ❑ Ready Now ill Call
i �You musf wl) the inspecror when ready) Date Ready:
I, �licensed confroctor ❑ owner hereb r uest inspection of the above electrical work at:
J ress ee, x or Route No.� � Ciy �� Z����
k `
Secfion . Township Name or No. Ranae No. Fire No. Cou
� Power Supplier
� Ma'I'"9 Address
/1r`C ELECT., fNC.
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Phone No. f �
�7 RI�
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY