P - 83344REQUEST FOR ELECTRICAL INSPECTION �
�.I' V 1- 4 6 8� Minnesota State Board of Electricity
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 Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remorks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection qvest will not be accepied withoui the correct iee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders F
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg.fTraffic Sig. Above 200 Am s Above 100 Amps
Transforme�/Generafor INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �S's�
Alarm/Remote Control
Swimming Pool
I hereb certi fhat I ins ted fhe elecfrical installation described herein on the dates stated
IrriQation Boom v,.,,..ki,, n,.b
Investigative Fee " �' -t ��v� - "2,� =c'sc�
THIS INSTALLATION MAY BE ORDERED DISC TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This roquest void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required? ❑ Yes
❑ No Inspecflon Ofher Than RougMn: Ready Now � Will Call
lD' ?- Q� (You must call ihe inspector when ready) Date Ready: -
I,` icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or R No.) Ci Zip Code
�si � _
$ecfion No. Township Name or No. Rana o. Fire No. Coun /1 /
'�V�.
A-11
Phone
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- SEE INSTRUCTIONS ON BACK OF
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Masfer Lic. No. (Pla
Phone No.
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