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' Commercial Industrial
Air Cond. Htg. Equi
Dryer Range
"X" above the work covered b
Calculate Inspection Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
REQUEST FOR ELECTRICAL iNSPECTIOIV
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other. New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy
�'/� l�C'�e/Y�
ction R t will not be accepted withovi fhe correct fee:
# Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100 Amps
INSPECTOR'S USE ONLY TOTAL _
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�Q:f�
Fee
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I hereb certi that I ins ed the electrical installation described herein on fhe dates stated
Irrigation Boom Rough-In Da�e
Special Ins
Firwl D �
Investigative ee �C:���`d
THlS INSTALLATlON MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesT void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Reque ate r^� Rough-in inspection required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: Ready Now ❑ Will Cal)
'� y (You must call ihe inspecfor when ready� Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
,� �d�i '� �°`a r Route No./ / �� ,�� ""�J:� Zss�3 �
Seciion No. I Township Name w No.
Occupant _
Power Supplier ��
E���°�'��e�°`����TR,c, �NC.
Fire No. County��/���
W
Pho N�� � `� /�
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o ac r License No. Master Lic. No. �Planf Elecf. i
�Oo7� 3 � /l?EG 3
�$ignature (Conha �Owner Performing Ins 'on) � �] � Phone No.
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�� 8�9 AT OARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY