P - 829805��-48� �
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Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work coverea
REGIUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 "�'
Apt. Bldg. Other: New Addn
farm Remod Re air
Water Hh. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
�n Request will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps .'Z 0 ro 100 Amps
Above 200 Am s Above 100 Ar
INSPECTOR'S USE ONLY TOT�
lZ�.,.o te.� G���f � £.�' g�rl�-'
Fee
Swimming Pool ��e �� ���s the e ' I installation described herein on the dales stafed
Irrigation Boom Ro�Mn l�,_
Special lnspec
Investigative Fee , � ��'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN MONTHS.
�E U� ONLY This request void 1 s from validafion date prinAed in this box.
IIIIIIIIIIIIIIIIIIII�I IIIIIIIIIII�IIIII�I�I .. `���
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* � 5 3 2 4 8 8 4 * pLEASE PRINT OR TYPE
Request Dafe q�j Rougftin inspection required$ �Yes ❑ No Inspecfion 01her Than RougMn: ❑ Ready Now Will Ca0
3'�� 7"" <!/ (You must call the inspector when reody) Dafe Ready:
I, ❑ licensed contracror�owner hereby request inspection of the above electrical work at: .�
Job Address (Streer, Box, w Roure No.) Ciy Zip Code
7 � �/ ��K so� 57� NF F ! �r. �sy3 �
Section No. Township Name or No. Range No. Fire No. C ty
Occupan� � � �
Power Supplier
/ �i /
Elechical Co�N6lffor �Company
or Owner
�°YO���
Plwne No.
•;.
Lic.
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