P - 83377REQUEST FOR ELECTRICAL tNSPECTION ��
7��'y ��/� � Minnesota State Board of Electricity
�+ 1821 University Ave., Rm. S-128, St. Paul, MN 55104 ��.
f 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 request. Enter remarks in this space and on the back of the white copy only.
. � ��%�- -
Calculate Inspection Fee - This Ins Request will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders F e
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR's usE oN�r TOTAL
Sign/Oudine Ltg. Xfmr. ����
Alarm/Remote Conhol
Swimming Pool
I hereb certi thaf I ins ted the elechical insiallation dexribed herein on the dates stafed
Irrigation Boom Rough-In Dare
Special Ins ti
Final Date /�
Invesfigativ � �2
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S months from validafion dafe printed in this box.
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PLEASE PRINT OR TYPE
Reques� Date � Roo h-in ins ion r uired$ ❑ Yes
/ . 9 P�� 8q ❑ No �nspection Other Thon Rough-In: Ready Now ❑ Will Call
�You must call fhe inspecfor when readyJ Date Ready:
I, icensed conhactor ❑ owner hereby request inspection of the obove electrical work at:
Job ddress (Sheet, Bo�oufe No.) n� I Ci ^ Zip Code
I Seclion No.
� roWe�
�qf No. Rq(ge No. Fire No. Cou
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Phone No. `
S )� '..
Address
,�(��(�. (� C hactor License No. / i
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vd. NW �j
Cytrr���y�ng Installafion)
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rc or Own�rf�rmina IncmllnK�,ISI / - -�
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STATE BO/�IRKCO�Y - SEE INSTRUCTIONS ON BACK OF YELLOW CO