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Home Duplex
Commercial Industrial
' Air Cond. � tg. Equi
� Dryer � � Range
"X" above the work covered b
REC�UEST 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 Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on the back of ►he white copy only.
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Calculate Inspection Fee - This Inspeciion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Lfg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S USE ONLY TOTA �.`
rn
Sign/Outline Ltg. Xfmr. �.�
Alarm/Remote Control
Swimming Pool
I hereb certi fhot I ins Ihe elechical installafion described herein on the dales sMted
Irrigation Boom Ra,9�,.�� ��
Speciallnspecti �
Final �
Investigative Fe
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED ITHIN 18 M NTHS.
OFFICE USE ONLY This request void 18 from validation date printed in this box.
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* 0 6 7 4 3 2 0 7* �%l�
PLEASE PRINT OR TYPE
Request Rou ffin ins ion r uired?
g pecf' eq ' ❑ Yes No Inspection O�er Than RougMn: ❑ Ready Now ill Call .
i �You must call ihe inspector when ready� Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Jo Address (Strcet, Bo , r Roufe No.� City ip Code
� ��PiV�litG�.S ` � �� 3
Section o. Township Name or No. RanAe No: Fire No. CounN
�Company Name� �
�i. �VV �iW�.� INC.
� e�rr�[ngfallafion�
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(Con act ner PerForming Insfallal
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STA E BOARD COPY -
Phone No.
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5 ON BACK OF YELLOW COPY