P - 80240REQUEST FOR ELECTRICAL INSPECTION
8��� � Q� � Minnesota State Board of Electricity ?3
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v 1821 University Ave., Rm. S-12S, St. Paul, MN 55104
Phone (612) 642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commerciai 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 remarks in ihis space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will noi be accepied 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 ONLY TOTA�
ie Ltg. Xfmr.
iote Confrol
Pool
� Investigative Fee � � (
THIS INSTALLATION MAY BE ORDERED DI;
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D IF NOT COMPLETED WITHIN 18 MONTHS.
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PLEASE PRINT OR�PE
�uesi Dale Rougl�in inspecfion required? ❑ Yes Inspecfion Ofher Than RougMn: dy Now � Will Call
� d Q� (You must call the inspector when ready) Date Ready:
icensed onhactor ❑ owner hereby request inspection of the above electrical work at:
Address (Sfreet, Box, or Route No.� City Zip Code
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:tion No. Township Name or No. Ranqe No. Fire No. Coun
Occupanf
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Power Suoolier
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STATE BOAflD
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INSTRUCTIONS ON BACK OF YELLOW COPY