P - 82912REQUEST FOR ELECTRICAL INSPECTION --
6 4/1 �'� �/I �, Minnesota State Board of Electricity
4�' �f �°:� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `�'
Home Duplex Apt. Bld . Other: New Addn
Commercial Industrial Farm Remod Re air
Air Htg. Equi . Wafer Htr. Load Mgmt. Other:
Dryer''�� Ronge Elec. Heaf 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 Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee Circuits/Feeders F
Mobile Fiome Pork Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR°S usE oN�v TOTAL i"1
$ign/Outline Ltg. Xfmr. ��' ��J
Alarm/Remote Controi '
Swimming Pool
I hereb certi that I ins the elecfrical installafion described herein on the dates stafed
Irrigation Boom RougMn Dare
Special (nspecti �
Final Da
Investigative Fee F%�- ....��
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WI IN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monihs from validation date prinfed in fhis box.
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PLEASE PRINT UR TYPE
Reques Dafe .�� Rough-in inspection required$ ❑ Yes ❑ No Inspection Other Than RougMn: Ready Now 0 Will Call .
(You must call the inspecfor when ready) Dafe Ready:
I,� icensed contractor ❑ owner hereby request inspection of the above electrical work at:
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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