P - 82964REQUEST FOR ELECTRICAL INSPECTION
��1- 9 7 9 Minnesota State Board of Electricity 13
s 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Neat Temp. Service
"X" above the work covered by this request. Enter remar in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspect�on Request 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 oNtv TOTA���
$ign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ed the el 'cal installation described herein on the dafes sMted
Irrigation Boom RoogMn � � G}
Speciallnspectio "�u� �
. . Final - q � a�,
Investigative Fee i�.
THIS INSTALLATION MAY BE ORDERED UISCONNECTED IF NOT COMPLETED WITHIN 1S MOKTHS.
.. , OFFICE USE ONLY This request void l�ths 6om validation date printed in this box.
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PLEASE PRINT OR TYPE
Requcst Date� �� �yh.)n inspecfion required? ❑ Yes No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call .
S� �`(ou must wll fhe inspecfor when ready� DaYe Ready:
I, �censed contractor ❑ owner hereby requesf inspection of the above electrical work at:
Job Add S�eet Box, or Ro No.) City Zip Code
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Section No. Township Name or No. Ranpe No. Fire No. Coun /
Occupant A
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Power Suppligr ,/J
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o� Qwner Performing
Phone No.
Address���� ���� ����
�� Co �r Licq�ysg Nga � Master Lic. No
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- EE NSTRUCTIONS ON BACK OF YELLOW COPY �