P - 8065677�-�09 �
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Home Duplex
Commercial Industrial
Air Cond. Htg. Equi
Dryer Range
'X" above the work covered b
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 Universiiy Ave., Rm. S-128, St. Paul, MN 55104 -
Phone (612) 642-0800
Other: New Addn
farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in ihis space �
;e,�v�a�.� ��� <
Calculate Inspection Fee - This Inspection Requesf wil! not be accepted withou► ihe correci fee:
Other Fee # Service Entrance Size Fee # Circuits/feedi
Mobile Home Park Stoll 0 to 200 Amps 0 to 100 Amps
Street Lfg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY Ti
Sign/Outline Ltg. Xfmr. Nb(_
Alarm/Remote Control � h z K-G `�
Swimming Pool
I hereb certi that I ins ected ihe elecirical installation described herein on the �
Irripation Boom R�,,,,�.i„ Da
copy only.
Fee
� Inveshgahve r� — + T v � �—.�— °.- - I / — / � �' 7
_ THI$_IN$TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monlhs from validafion dafe prinled in fhis box.
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PLEASE PRINT OR TYPE
Request te � Rou h-in ins tion r uired$ ❑ Yes
g pec eq ❑ No Inspeclion Other Than RougMn: ❑ Ready Now ❑ Will Call
�You must call the inspector when ready� Date Ready:
I, ' ensed ontractor ❑ owner hereby request inspection of the above elecfrical work at:
lob Address (Sheet, Box, or Route G Zf
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Secfion No. Township Name or No. Range No. Fire No. Counly n
Occupant
✓ �/ �
or bwner Performing
Phone No� �/—�, /!
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C actor, Li� nse N�� . /� ter Lic. No. (Plant Elect.
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELIOW COPY