P - 84552REQUEST FOR ELECTRICAL INSPECTION -
,.'�i "'V �� 6 61 Minnesota State Board of Electricity -
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
ome Duplex Apt. Bldg. Other: New Addn
C mercial Indushial Farm Remod Re ir
ir Cond. Htg. Equip. Water Htr. Load Mgmt. Other. -�� �� J2�����
Dryer Ronge Elec. Heat Tem . Service
"X" ve the work covered by this reque� er remarks in ihis space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspeciion Requesi will not be accepied without ihe correct fee:
Other Fee # Serviee Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�s usE oN�r TOTAL O
Sign/Out�ine Ltg. Xfmr. �.� - S
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins the electrical installafion dexribed herein on the da�es stated
Irrigation Boom RougMn pare
Speciallnspec '
Investigative Fee R• Final � pa�� ,Z �_ G�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request void 18 months from validation dafe prinfed in this box.
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* � 4 6 9 6 Ea L 3* PLEASE PRINT OR TYPE �j �D
R�� �� � � Rough-in inspection required$ ❑ Yes ❑ No Inspeclion Olher Than RougMn eady Now 0 Will Call
(`(ou must call the inspecfor when ready� Dafe Ready:
I, ensed contractor ❑ owner hereby request inspection of the above elechical work at:
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Conhacfo� License No.
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