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Home Duplex Apt. Bldg.
Commercial Industrial Farm
REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
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' Air Cond. Hig. Equip. Water Htr. Load Iv�'gmt. Ot� �` �,p
Dryer Range Elec. Heat Temp. Service �� / 1�+�'�\
"k' above the work covered by this request. Enter remarks in this spa e and on the back of the white copy nly.
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Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee � Service Entrance Sae Fee # Circuifs/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'SUSEONLV TOT1►� �
Sign/Outline Ltg. Xfmr. L("J•
� Alarm/Remote Control .�J
$wimming Pool
i hereb certi ihat I ins ecled fhe eledrical insfallotion described herein on the dates sTated
Irrigdtion Boom '"' Rou h-In
9 Date
Special Inspedion
Investigative Fee F"p� �2
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MONTHS.
3��-18 6� OFFlCE USE ONLY This requesf void 18 months from validation dofe prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspedion required2 � Yes � No Inspeclion Other Than Rough-In:
Z� (You must call the inspector when ready) po� R�dy; �Z,�
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo Address $t�, B z, or Route No.) Ciy
Setfion No. Townshi N� or No. Range No. Fire N���Counw
Power $upplier ��
Ele a� �pr� ny a
Mailin dross (Confrador or Qw
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4� oon,re (con , a.
B-OOOOlA-10 6/95
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] Ready Now � Will Call
z�ode !3�_
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I PhqAe No. � �� ..
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L�� e No. Master Lic. No. (Planf Elecf. Only)
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� Phone No.
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STATE BOARD COPY- SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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