P - 83351RE(�UEST FOR ELECTRICAL INSPECTION ��
7�✓�C� � 5 9 7 0 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 ��.
Phone (612) 642-0800 `'�'
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod e air
Air C�� tg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above e work covered by this request. Enter remarks in this space and on ihe back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted wi ou e correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
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 ONLY TOTAL�
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the eleckical insmllafion described herein on the dates smfed
Irrigation Boom RousaMn Dare
Investigative Fee � �, � I ����^-�^U �
THIS INSTALLATION MAY BE ORDERED d CTED IF NOT COMPLETED WITH 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date in this box.
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PLEASE PRINT OR TYPE
Reque f Dafe Rough-in inspeclion required$ ❑ Yes o Inspection Other Than Rough-In: dy Now ❑ Will Call
�� "� �� (You must call fhe inspecror when ready) Dafe Ready:
I, ,�licensed confractor ❑ owner hereby request inspection of the above electrica! work at:
Job Alddres�1Sheet, Box, or Route No.� � Ciy _ Zip Code
No.
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Phone
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Conkaclor (Company Name�� � � � Conpp� LicenselJo. .� � Master lic.
or
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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