P - 84546REQUEST FOR ELECTRICAL INSPECTION
� 2 9��`� � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
ome Duolex Apt. Bld4. Other: New Addn �
Commercial ndustrial Farm Remod
Air Co . Htg. Equip. Water Hh. 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
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps to 100 Amps
Sheet Ltg./Traffic Sig. Above 200__Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY � TOTAj�
�ign/Oudine Ltg. Xfmr. �
Alarm/Remote Conhol
Swimming Pool
I hereb certi fhaf I ins the elechical insMllafion dexribed herein on the dafes stated
Irrigation Boom Rough-In Dare
Special Inspectio
Fee
� �
Fual 1 i
Investigative Fee �—CC.���"*-� _ 1� �� �
_THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date printed in fhis box.
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* � 4�G 9 4 3 L 0* PLEASE PRINT OR TYPE
Rough-in inspecfion required? ❑ Yes o Inspecfion Other Tha gh-In: dy Now � Will Call
(You must call fhe inspecfor when ready) Dafe Ready:
censed confractor ❑ owner hereby request inspection of the above electrica work at:
su �Sheef, Box, or Roufe tJo.) ��� Ciiy �� / Zip Code
Name or No. � � Range
0
Power
Electrical Confracfor �Company Name�
� ies Electric
Mailinq Addreu IC r or OyWerr€i
alnon CA01539
Street - South t�
� �oatananon) !
� 7�} -ODl2
Masfer Lic. No. �Plant Elect. Only�
1, MN 55075-1195
/l Phone No.
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:LLOW COPY