P - 82718REQUEST FOR ELECTRICAL INSPECTION -
5� O w��� Minnesota State Board of Electricity -
1821 University Ave., Rm. S-128, St. Paul, MN 55104
' Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remar s in this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request wil not be accepfed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 ro 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT�� �
Sign/Oudine Ltg. XSmr. �
Alarm/Remote Control
Swimming Pool
I here certi that I in ihe electrical ins�llafion described herein on the dales sta�d
Irrigation Boom RagMo �
Special Inspecfio �
Final . -.. .
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- OPFICE I�E OfILY Thia requesf vad 18 months from wlidation dafe printed in this box.
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* � 5 6 0 2 L� J� * PLEASE PRINT OR TYPE
R�1� —� _ ry Rough-in inspection required? � Yes o Inspection Other Than RougMn: ❑ Ready Now �II Coll
T(You must call the inspecfor when ready) Date Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job^ reu (Aheet, Box, o�Roure'lo.i . / Ciy ,.. /� Zip Code �
or Nq( � Range No.
I Occupanf � N����/� � I Phone No.
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' / Address�//� �/��j /�%i'V '-'
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�qJ Name , -- ctor Li o. Master lic. No. �Planf Elecl. Q
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STATE BO R COPY - SEE INSTRUC770NS ON BACK OF YELLOW COPY