P - 84461�3�=�263
Home Duplex
Commerci Industri
Air Con Htg. Ec
ryer Range
"X" above the work covered
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_ �QUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Apt. Bldg. Other: New Addn
farm Remod Re ir
Water Hh. Load Mgmt. Other:
Elec. Heat Temp. Service � ���
request Enter remarks in this space and on ihe back of the white copy only.
CalculaFe Inspection Fee - This Inspection 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
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ��, �
Alarm/Remofe �ontrol
$wimming Pool �
1 hereb certi that I ins ed the elechical installation described herein on the dates stated
Irrigation Boom = - Roo,qM� pa�
Special Inspect"
-� Final ' ^ �
Investigative Fee -
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required2 ❑ Yes o Ins ion Other Than Rou Ifln:
—� I�Q P� 9 ❑ Ready Now ill Call
–( (You must call the inspecror when ready� Date Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Addreu (Streef, Box, w Route No C� P
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Section No. owr
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Eleclriwl Confractor
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