P - 83408REQUEST FOR ELECTRICAL INSPECTION ��°
Minnesota State Board of Electricity
���- 6 9 9� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
� Phone (612) 642-0800 "°°a'
mercial � � Industrial
Apt. Bldg. Other: New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks ' this space and on the back of th white copy only.
` �9 � �- ��2�,
Calculate Inspecfion Fee - This Inspection Reqvest will noi 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 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT�,4L
Sign/Outline Ltg. Xfmr. /�^ � ��
Alarm/Remote Control "�
Swimming Pool
I hereb certi that I ins ected the elecfrical installation described herein on the dates stated
Irrigation Boom Ro�Mn �re
Speciallns i
F�^°' °°� Z,- o d
Investigative ee �'
THIS INSTALLATION MAY BE ORDERED DISCON D IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months (rom validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
- ` (You musf call the inspecfor when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
J, Addre �Street, Box, or Route No.) ity �� Zip Code
!S'.S� /( � �i� /' . �� , lii l Z�S/ ��
or No. I Range No. I Fire No. � I Counfy
«V V���T�7'_a�g
�_ � I Phon�� �
License
�- ? � Phone No.
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COPY - SEE INSTRUC770NS ON BACK OF Y W COPY