P - 83822REC�UEST FOR ELECTRICAL INSPECTION �
�, � � � � � � � 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 Indusfrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ihe back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be occepted 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 TOT{4L��-�
Sign/Outline Ltg. Xfmr. y� �
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ecied fhe electrical installation described herein on the dotes sfated
Irrigation Boom Rouglfln ' Date
Speciallnspecti ,w
9 . ^ Final � Dafe � z C,�_ ^
Investi ative Fe ► 1 Z y
`THIS INSTALLATION MAY �E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 11fiONTHS.
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OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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* � 4 8 8 6 9 7 4* PLEASE PRINT OR TYPE �J� .�v
Re uesf Dafe Rou h-in ins tion re uired?
% C g pec q ❑ Yes �6% Inspeciion Other Than Rough-In: eady Now Q Will Call
,� e/� ✓/�3� t�(You musf call fhe inspector when ready) � Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Add�ess (Sheet, Box, or Roufe No.) Cify Zip Code
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$ection No. Township Name or No. Range No. Fire No. County ��� ���
OccuPanf Phone No.
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Power Suoolier Address
��.I Contractor (Company Name) ,� ' Confracfor License No. � Master Lic. No. (Plant Elect. Only)
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Add�ess �Conhactor or Owner Performing Insfallafion)
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ed�ture onkactor ner Performing Installation) �[" r Phone o.
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�A-� � 8 STATE BOARD COPV - SEE INSTRUCTIONS ON BACK OF YELLOW COPY