P - 83046REQUEST FOR ELECTRICAL INSPECTION
� � � �.� /� � � Minnesota State Board of Electricity
�� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" obove the work covered by this request. Enter remarks in this space and on the back of the whil
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Calculate Inspection Fee - This Inspection Request will not be accepted withouf fhe correct fee:
Other Fee # Service Entran Size Fee # Circuits/Feedi
Mobile Home Park Stall 0 to 00 Amp � 0 to 100 Amps
Street Ltg./TraFfic Sig. Above 200 Amps Above 100
Transformer/Generator INSPECTOR'S USE ONLY T�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
New
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copy only.
Fee
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I hereb certi that I ins ihe electrical installafion described herein on ihe dafes stated
Irrigation Boom Ro�Mn Dare
Speciallnspecti +;)
Investigative Fee F�� � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required6 ❑ Yes No Inspacfion Other Than Roug n
�You musf call ihe inspecfor when ready) Date Ready: �
I, �licensed confractor ❑ owner hereby request inspection of the above elecfrical work at�
lob Addf ess �Streef, Box, or Roufe No.) . � Ci .
L� Dic� /Y)� 1�„�.�.. f�l Nt' �^► d�-�,
Secfion No. � Township Name or No.
Owner
or
ST
Phone No.
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Ready Now 0 Will Call
Zip
Conhacior License No. Masfer Lic. No. �Planf Elecf. Only)
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY