P - 82782REQUEST FOR ELECTRICAL INSPECTION � �
5�' C� 3��1 Minnesota State Board of Electricity
�� -�� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commetcial Indushial Farm Remod Re air
Aireond. Htg. Equip: < Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space ond on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will noi be accepied 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 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT+A�L
$ign/Oudine Ltg. Xfmr. �� 2.�� � �J �es�
Alarm/Remote Control
Swimming Poo)
1 hereb ceAi that I in Ihe elecirical insMllafion described herein on the da�es staled
Irrigation Boom RoogMn � Q
Special lnsp 6
Final .� C� .
Investigative /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OfRCE USE OlR.Y This request void 1.8 months from validafion da�e printed in �his box.
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* 0 5 6 5 3 1 1 8* �700
PLEASE PRINT OR TYPE
R89ues� Date Rou h-in ins on r uired$ � Yes
�� g pecfi eq ❑ No Inspection Olher Than RougMn: ❑ Ready Now Q Will Call
^% � C�. (You must call the inspecror when readyJ Date Ready:
I, � licensed conhacror ❑ owner hereby request inspecfion of ihe above elech�ical work at
Job Add1ess (Sheet, Box, w Route No.� � Cily . t Zip Code
, , s � r, c!
Seclion No. Township Name w No. Range No. Fire No. �ty
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Occupant Phone No.
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4vner PerForming Installafion) `
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or ing In lah ��`��� Plwne No.
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TATE B D COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY � �