P - 82630% F REQUEST FOR ELECTRICAL INSPECTION �'.HE,\
�.'�O r'��`-� � Minnesota State Board of Electricity �".� -_ 04 �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 .� �
r! (651) 642-0800 www.electricity.state.mn.us :� '
Other: add GFI's,smokes, IigMs
ommercial Intlustrial farm rsemuu ne
ir Contlitioner Htg. Equip. Water Htr. Load Mgmt. Other:
ryer Range I.J Elect. Heat I_l Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
1-OQ7-746 5969-2000 � Inspected Locally
Rok�ert Clausotl Project thru Moka County Community Action Program Inc.
(651) 777-7885
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Sign / Outline JQg j�9 fry
Alarm/Remote Control
Swimming Pool
Irriaation Boom a
Size Fee
0 to 200 Amps �
Above 200 _ Amps
INSPECTOR'S USE ONLY
I hereby certify that I inspected the electrical
Rough In
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
� `,� �110. S�
described herein on the dates stated:
Date
� - Fiwe+ / — // __�.. "°�—�L.��--a �
vestigative Fee � —�r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN S8 MONTHS.
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IIIIII IIIII IIIII IIII I OFFICE USE ONLY "This request void 18 months from validation date printed in �this box.
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* 1 0 0 7 7 1* ����(J
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required?�Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
�rc�nn You must call the inspector n ready! Date Ready: �
I, �censed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: