P - 79949REQUEST FOR ELECTRICAL INSPECTION �
Q f1 ��� Q G Minnesota State eoard ot Eledriciry
(� U v V 1821 Universiry Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800 �'�°�
Home Duplex Apt. Bldg. Other? 2/jj New Addn
Commercial Indusfrial Farm /��0 Remod e air
Air Cond. Ht . Equip. Water Htr. Load Mgmt. ther:
Dryer Range Elec. Heal Temp. Service
"X" above fhe work covered by is requesG Enfer remarks in �his space and on the bock of ifie whife opy only.
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Calwlote Inspection Fee - This Inspection Requesf will r,ot be accepred withouf the correct fee:
Other Fee fi Servi e Enhanc 'ze Fee p Circuits/Feeders Fee
Mobile Home Pork Sfall 0 to 00 Amps 0 l0 100 Amps
Sheet Ltg./Traffic Sig. Above 200_Am s Above 100—Amps
Tmnsformer/Genemtor INSPECTOR'S USE ONLY TOTA4 , ST
Sign/Outline Ltg. Xfmr. �� ��
Alarm/Remote Control
Swimminy Pool I hereb ceni iha� I inr ened+he elenricol insmlloiion descnbed here�� a� �he daies sm�ed
Irrigafion Boom ao�yhi� . � ��G Z�3–dj
Special Ins F��al �
Investigalive Fee 6 _L�° P
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�FFICE IISE ONLY TFiv �equest vo'w 18 monlhs fmm volidation dme pnMed In fhia 6ox.
I nIl II III II III II III II III II III �I III II III II III I IIII
* 0 8 0 2 2 8 6 5* �5987
PLEASE PRINT OR TYPE �/5 �
ae9�e,� oma / Rough I� Inspecnon rEqolredg ❑ ve, ❑ No i�,a�rro� O�her Than RwgMn: ❑ Reody Now 0 w�n coii
� � ir.! ( rou mosi mll �he inspecror when ready� Dote Raody
I, ❑ licensed conhaclor�owner hereby requesl inspection of the above electrical work ot
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Senion No. Township Name or No. I Range No. Fire No. Cwny
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occvpont � Phone No. �
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Pawer Suppli Address
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