P - 79826��Q2-347 �
Commercial Industrial
Air Cond. Htg. Equi
Dryer Range
"X" above the work covered b
REQUEST 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
request. Enter remarks in this space and on the back of the whife copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepfed wiihouf the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Amps Above 100 Amp:
Transformer/Generator INSPECT�SE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �� -� �
Alarm/Remote Confrol
Swimmin P I
�,
9 I hereb certi that I ins the elechical installafion described herein on the dates stated
Irrigation B RougMn ��_ Da� � G�
Imestigative Fee f �� ���
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months (rom wlidalion dafe pnn n this box.
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* 0 8 0 2 3 4 7 5* ��• J`�
PLEASE PRINT OR TYPE
Request te Rou f�in ins on r uired? Yes
g pecli eq ❑ No Inspecfion O�er Than RougMn: ❑ Ready Now Will Call
gS�+� (You must call the inspecfor when ready� Date Ready:
I, ❑ licensed conkactor � owner hereby request inspection of the above electrical work at:
lob Addreu (Streef, Box, or Route No.) City - Zip Code
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Seclion N
Occupanf
rical � hacfor (Company Name�
ing Address �Conhacfor or Owner Performing Installafion�
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on�an re IConhaMOr or�er�erformina�
�� 8 STATE B RD COPY - SEE
Phone No.
3-S - 2_0 ? !
:onhacfor License No. Masfer Lic. No.-�Planf Elecf. Only)
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ON BACK OF YELLOW COPY