P - 83163RE(�UEST FOR ELECTRICAL INSPECTION
6 1.� 1- 9� 2� 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
ir Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requ Ente remarks in this space and on the back of the white copy only.
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Caiculate inspection Fee - This Inspeciion Request will not be accep►ed withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps Z 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generpto� INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. i �
Alarm/Remote Confrol
Swimming Pool
I hereb ceAi fhat I ins the elecfrical insfallafion described herein on fhe dafes sfafed
Irrigation Boom Ro�Mn Dare
Speciallnspecti � -
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 1 MONTHS.
_ �-= __ — — — — —.— -- —
,. OFFICE USE ONLY This requesf void 18 months from validafion date prinfed in Iliis box.
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* 0 6 0 1 9 5 2 5* o2��g
PLEASE PRINT OR TYPE
Request Dpf�i� /� Rou h-in ins ion r uired?
�� �A 9 P�� eq ❑ Yes o Inspecfion Other Than Roughan: Ready Now ❑ Will Call
7 (/ �You must cal) the inspecror when ready) Date Ready:
I, censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job ljddress (Sheet, Bo r Ro fe o.) A��� City �.. �/ Zip Code
� C�i �, ;�
Section No. Township Name or No. Range No. Fire No. ounty n �
7%��%
Occupant f�� / /��� Phone No.
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Atltlre55
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�ompan�me) ` Cnont�}or Licgn,se o. Master Lic. No. (Plant Elect. Only)
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Yacfo� or Owner Pe ing Installafio
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onha r Owner Pe i Ins I`tion) :; ';��. � Ph //
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STATE B A OP - SEE INSTRUCTIONS ON BACK OF YELLOW COPY