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REQUEST FOR ELECTRICAL INSPECTION ��G�,�`'°'�'
Minnesota State Board of Electricity `���.;
1821 Universiry Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800 ! 01� ....;�".
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� Elec. Heat � � Temp. Service �
request Enter remarks in this space ond on
copy
Cafculare InspecM1On Fee - This Inspecfion Request will no/ be accepfed withouf �he mrrecl Fee:
O[her Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps � 0 to p
Sheet Lt ./Traffic Sig. Above 200_Amps Above 100_Am
Transkrmer/Generaror INSPECTOR'S USE ONLY TOTA
Sign/Oudine 11g. Xfmr. . �
Alorm/Remo}e Con}rol 2 �k �'� f � � �
v N � �
Fee
sa
$wimming Pool i he.eb cea�Iy ^har I'��: ecied rhe elxrc�ml �nsallaea� desdbed he�e�n on ihe daies noied
Irrigafion Boom go�yhi� oar�
Speciallnspeclion
Flnal � D ^0 /
Invesfigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN /8 MONTHS.
. OFFICE USE ONLY This requeS roid 1 B monlfis from valldafion dare prinfed in iks box.
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* 0 8 0 2 2 8 9 9� /�(0//6 �� �
PLEASE PRINT OR TYPE
keqoest Dare �. � Rough in inspecnon reqairedi ❑ Yes ❑ No Inspenion O�her lhan Ragh In: ❑ Ready Now � WIII Coll
6- 30 - o/ (YOU mon mll �he inxpecmr when ready� Oote Ready
I, ❑ licensed conhaclor�owner hereby request inspection of Ihe above electrical work at
Jo/b Address �Sne�, ew�, « j k No.� Ciy � � Lp Code
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