P - 83480RE(�UEST FOR ELECTRICAL INSPECTION --�
V�� �� 9 3 7 Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Con� Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
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Calculate Inspection Fee - Ihis Inspection Request will not be accepted without the 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
$wimming Pool
I hereb certi that I ins ected the elechical installation described herein on the dates stated
Irrigation Boom Rough-In �O�
Special Inspection
Final / D . ..,�%� �_ �
Investigativ /
THIS INSTALLATIO A BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S.
� OFFICE USE ONLY This request void 1@ monfhs from validation date printed in this box.
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PIEASE PRINT OR TYPE
Request fe' `�� Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: eady Now ❑ Will Call
(You must call the inspector when ready� � �Date Ready:
I, 'censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box or Roufe o.) Cily .�j� Zip Code /%
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Section o. Township Name or No. Range No. Fire No. Couny �
Occu�ant � �� Phone No. � � / / � �
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Pow S plie� ��� Addr s t I� �� ��
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Elechical Contmctor Company Na e�i/ �/j _ Contmctor Lice�o�� Master ic. No.�lqnt EI�
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Maili g Address (Confractor or Owner Performing Instal ion) �a
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Aufhori d Si nature (Contmcfor or Own Pe °�) Ph��� ��
E&00001 A-1 1 8/96 gOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY