P - 83035REQUEST FOR ELECTRICAL INSPECTION
6 Q 8_ 19 8 Minnesota State Board of Electricity
182i University Ave., Rm. S-128, St. Paul, MN 55104
`. � Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New I
Commercial Industriol Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy c
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Calculate Inspection ee - This Inspection Request wiil noi be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 1 UO Amps
Transformer/Generaior INSPECTOR'S USE ONLY TOTAL /j
Sign/Outline Ltg. Xfmr. ! `�
Alarm/Remote Control
Swimming Pool
I hereb cerTi thot I ins ed the eleclrical insfa�lafion described herein on ihe dales stated
Irriqation Boom Ro„a�,-�„ D�e
Fee
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
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P EASE PRINT OR TYPE
RP�oj✓j� /� Rough-in inspecfion required? ❑ Yes No Inspecfion Ofher Than Rouglfln: ❑ Ready Now Will Call
� �� j� (You must call the inspettor when ready) Date Reody:
I, licensed conhacror ❑ owner hereby request inspection of the above elechical work at:
Job dreu (Strcet, 8ox, Ciry Zip Code
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Section No. Township Name or No. Range No. Fire No. ouny �� �
Occupant � '
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Power
� Phone No.
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Address �/�/ � /- �/, / _
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lame� Conh or Lice o Master Lic. �10. �Plant Eleci.
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STATE BOA D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY