P - 81529REQUEST FOR ELECTRICAL INSPECTION
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� Q�-� 5 6 Minnesota State Bo�rd of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
ome Duplex Apt. Bldg. Other: New
Commercial Industrial Farm ; Remod
Air Cond. Htg. Equip. Water Hfr. 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 acce
Other Fee # Service Entrance Size
Mobile Home Pork Stall 0 to 200 Amps
$freet Ltg./Traffic Sig. Above 200 Am
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Outline Ltg. XFmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi fhat I ins fed fhe
Irrigation Boom Rough-In
without ihe correct fee:
Fee # Circuits/feeders Fee
0 to 100 Amps
Above 100 Amps
TOTi� �
described herein on the dates
Investigotive fee " � V C) •••-• " —�
TYIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH .
OFFICE USE ONLY This requesf void 18 monfhs from validofion date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required8 ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
3���� (You musf call the inspector when ready� Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Skcet, Box, Route No.) Ciy Zip Code
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$ecfion No. Township Name or No. Range No. Fire No. Coun
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Phone No.
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jCompany Name)
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nh941or or Owner Performing Insfdipfion)
or
License No. Master Lic. No. �P
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Pho^ne No.
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HACK OF VELLOW C�PY