P - 81585• ' • � �,
Home Duplex Apt.
Commercial Industrial Farm
Air Conditioner Htg. Equip. WatE
REQUEST FOR ELECTRICAL INSPECTION °•�
Minnesota State Board of Electricity ':3
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.electricity.state.mn.us '��'
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nt. Other:
�ryer I I Range I I Elec. Heaf I I Temp. Service I
"X" above Ihe work covered by thrs request Enter remarks in �his space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Requesf will not be accepted without fhe correct fee:
Other Insfallations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Lig. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE OMLY TO�i4L/
Outline Ltg. Xfmr.
Remote Control
ing Pool
described herein on the dates
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irngarion oo RougMn Dare , ` �L��
Special Inspection
Final � Dafe �� .Z __y� .
Investigative Fee " T�
THIS INSTALLATION MAY BE ORDERED DISC NNECT IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S months from volidafion dafe printed in ihis box.
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PLEASE PRINT OR TYPE
R89�� �^� Rough-in inspecfion required$ es ❑ No Inspection Other Than Rough-In: ❑ Ready Nowyp vvill Call
�� j- � b(� You must call fhe inspecfor wh n ready Date Ready: ���
I, ' nsed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.) ` ' Ciy Zip Code .� /
0�3 � L,OrI I� i�Ow � �r' idle �� S�Y��
� Section No. Townshio Name or o. Ranae No. fire No. County
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�i'Yr�( GY'i(;t�>or�
bt,.'�,'�^ �l��juY
g Address �Conhacf r, Company or �
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�ized Signature �Contracror, Compam
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STATE BOARD COPY
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Phone No.
-7 i�� — 7�30 — D(a(o �
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Phone Number
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY