P - 80752REQUEST FOR ELECTRICAL INSPECTION
8� C� w 8 4 9 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '��
ome Duplex Apt. Bldg. Other: New Addn
ommercial ndustrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remorks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
% L.liiJ�' `.
> uest will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits/Feedi
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100
INSPECTOR'S USE ONLY T�
F�
Sign/Oudine Ltg. Xfmr. 'l �• �
AlarmfRemote Conkol M�' ���
Swimming Pool
I hereb certi ihat I ins the elechical insfallafion describad herein on the dates sfafed
Irrigation Boom R«�pMn Dare
Speciallnspecti � � .
Investigative Fee ':x � ���� °�l�'Z z '��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This requesf void 18 monfhs from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Reque Dafe Rough-in inspecfion required? ❑ Yes ❑ Will Call
❑ No Inspection Ofher Than Rough-In: Ready Now
•/�- (You musf call ihe inspector when ready) Dafe Ready: .
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I, ' ensed conhacror ❑ owner hereby request inspection of the above elechical work at:
Job ddress �Sheet, Box, or Route No.� Ciy Zip Code
.S� � � 3 a
Secfion No. Township Name or No Range No. Fire No. County �� �
Occupant
Power Supplier �' W
Eleclrical Conhactor (Company Name�
(Conhacfo�er Perfortning
Phone No.
��. � -9'�!
License No.
i v ��
1 8/96 STATE B COPY - SEE INSTRUCTIONS ON BACK OF
Master lic. No.
No.
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