P - 8383754�--961 �
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REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �'�'�
n��,e.- New Addn
Commercial I dustrial Farm Rernou - �� ���
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis 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 withouf 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 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereb certi fhat I ins ted ihe electrical insfallation described herein on ihe dates stafed
Irrigation Boom Rough-In �°�e
Special Inspecti pa ��
. Final .'����.,�.t_,,. il =.. � -
Investigative Fe ° 6
THIS INSTALLATION MAY BE ORDERED D_ NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monihs from validation date printed in fhis box.
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Re st D Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now ❑ Will Call
�� .i�� (You must call fhe inspector when ready) Date Ready:
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I, I' ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address Sheet, Bo� Route o.) Ci I Zip Code �
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Secfion No. Township Name or No. Range No. Fire No. County �I�
Occupan / ' .^ ^ � ` /�i�� Phone N���—. � ^ ^ ,
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Power
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hacfor or Owne�adc ing Insfallatic
�Conhactor or Owner Pe orming I a
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Conhactor License
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Master Lic. No. (Plant Elecf.
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