P - 83280REGIUEST FOR ELECTRICAL INSPECTION
6 O��� 5 9 7� Minnesota State Board of Elec',ricity . �
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
. ' Phone (612) 642-0800 `�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspec►ion Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Alarm/Remote Control
Swimminq Pool
m Request will not be acce
# Service Entrance Size
0 to 200 Amps
Above 200 Am
INSPECTOR'S USE ONLY
without the correct fee:
Fee # Circuits/Feeders
ap 0 to 100 Amps
Above 100 Ar
herein on the dates
Fee
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�(nvestigative Fee � � � �C5—'� —� ll
:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
DFFlCE USE ONLY This request void 18 months (rom validafion date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes o Inspection Olher Than RougMn: eady Now ❑ Will Call
/O ��� 4 � (You must call the inspector when ready) Date Ready: �� s�' -� Y
I, ,�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sfreet, Box, or Roufe No.) � Zip Code
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Mailing Addre (Conkactor or Owner Performing Installation)
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Aufhorized ' nature �Conhador or Owner Performing 1 stall ' n)
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B-000 A-1 1 8/96 STATE BOARO COP - SE 11
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Phone No.
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Confraclor License No. Masler Lic. No. (Plant Elect. Only)
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Phone No.
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OF YELLOW COPY