P - 83586REQUEST FOR ELECTRICAL INSPECTION �
7��� 0 O� � Minnesota State Board of Eiectricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
` Phone(612j642-0800 "�'
Home Dupiex Apt. Bidg. 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. .nter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Ins fio eqvest will not be accepted without the correct fee:
Other Fee # Service Entrance Seze 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
7ransformer/Generator INSPECTOR'S USE ONLY TOTA� ���
Sign/Outline Ltg. Xfmr. �� ' � 1G'—o� ��„�
Alarm/Remote Conhol
Swimming Pool i
! hereb cerfi that I in ted fhe electrical installation dexribed herein on the date� sfaled
Irrigation Boo RougMn Dare'
Special lns
p.�.H---- oare
Investigative Fee -
THIS INSTALLATION MAY BE ORDERED DiSCONNECTED tF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 16 monliis from wlidation date prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Date '�� Rough-in inspecfion required$ ❑ Yes ❑ No Inspecfion Other Than RougMn: Ready Now 0 Will Call
�� (You musf call Ihe inspector when ready� Date Ready:
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I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
JobAddress (Sheet, Box, or Roufe No.) City Zip Code
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Section No. Townshi Nome or No. Range No. Fire No. Couny .
W
Occupant Phone No.
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Power Supplier �� Addreu
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��� �%���m�L ��n � V. I N • Confracfor License No. Masfer lic. No. (Planf Elecf. Only)
►ag 81�a. �vw �O i���.�
�1�� A����{��ntr��r �r� riVing Installafion� .
Authorized Signafure �Conhacfor ner Performin8 Inslallafion - Phone No.
�15�-.�OyO
,.. EB40001 - 1 8/96 ..__._
STATE B R COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY