P - 83220REQUEST FOR ELECTRICAL INSPECTION _
� � � � � � � � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercia! Industrial Farm Remod Re ai
Air Con 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 and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Requesi will not be accepted withouf the correct fee:
Other Fee # Service Entrance Size Fee # CircuitsJFeeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Am s
TransformerJGenerator INSPECTOR'S USE ONLY TOTAL
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pooi
I hereb certi thaf I ins fed fhe elechical installafion described herein on the dafes sta�ed
Irrigation Boom RougMn �r�
Special Inspecti
Investigative Fee Finol �� , �
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This raquest void 1 S months from validation date printed in tfiis box.
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PLEASE PRINT OR TYPE
Requesf Date�O ,� Rougfrin inspecfion required$ ❑ Yes ❑ No Inspecfion Other Than RougMn: Ready Now 0 Will Call
(You must call the inspecfor when ready) Date Ready:
I; censed contractor ❑ owner hereby request inspecfion of the above electrical work at:
Job Address �Street, Box, or Route No.) City Zip Code
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� Phone No.
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/� Address
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iy Name) C h r License No. Masfer Lic. No. (
ECTRIG.INC, �3� .
9lnsfallafi0�) � ^�
55433 u i ?
ner Performing In I fion) Phone No.
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ATE OA COPY - SEE INSTRUCTIONS ON BACK OF YELLO Y