P - 81048REC�UEST FOR ELECTRICAL INSPECTION
� � � .� � � � � Minnesota State Board of Electricity
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104
- Phone (6i2) 642-0800 `�°'
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
„X" above the work covered by this request. Enier remarks in ►his space and on the bock of !he white copy only.
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Colculate Inspection Fee - This In tion 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
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generaror INSPECTOR'S USE ONLY TOTAL ,��-.. �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming PoQI I hereb ceni fhat I ins red fhe
Irrigation Boom R�„
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nnrn
Investigative Fe `' �'L --cti.
THIS INSTALLATION MAY BE ORDERED DtSCONNECTED IF NOT COMPLETED WITHIN i8 MONTHS.
..... OFFICE USE ONLY This requesf void 18 monihs from validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE
Reques te RougMin inspecfion required2 ❑ Yes ❑ No Inspecfion O�er Than Rouglrin: eady Now Q Will Call
'�'� •� (You must call the inspeclor when ready) Date Ready:
I, � censed confractor ❑ owner hereby request inspection of the above electrical work at:
Job ddress (Street, Box, or Route N� City r.� � Zip Code f
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or rfo. � Range
Phone No.
W
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(Company Name) Conkactor License No. Masfer Lic. No.
I F Fi �r.TR�r. in�n �,/�1�0?�3� /11E�
No.
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COPY - SEE INSTRUCTIONS ON BACK OF