P - 83311REQUEST FOR ELECTRICAL INSPECTION
�("� [� I") /� p � Minnesota State Board of Electricity
�:J J L't O 1821 University Ave., Rm. S-128, St. Paul, MN 55104
' Phone (612) 642-0800 ���
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enter 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 withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ,�„
Swimming Pool
I hereb certi that 1 ins fhe elechical installation described herein on the dates stated
Irrigdtion Boom � Rough-In pa�
Speciol Inspectio
Final p
Imestigotive fee —
THIS INSTALLATION MAY BE ORDERED DISC TED IF NOT COMPLETED WI HIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monihs from vali tion date prinfed in this box.
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N Iil II III II Ii�N II III II IN I liil
* 0 7 0 5 2 4 8 3* /��
PLEASE PRINT OR TYPE � '
Request Date /� � Rough-in inspection required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
� I��` (You must call fhe inspector when ready) � Dafe Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, w Route No,) City Zip Code
Caoo i �d. t� � id� s�32
Section No, Township Name or No, Range No. Fire No. Cou n
Phone No.
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Contracror license No. Master Lic. No.
arc. r�01�1°II.P
i re �Co� ctor or ner Performin�lnstallation) A�j ��('� I Phone No.
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1/96,,,,,�,,�k,�,�....� �7E8E3ARQCOPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY