P - 82260REQUEST FOR ELECTRICAL INSPECTION �:�,
8�; � o� O� � Minnesota State Board of Electricity 'a
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '� '
Commercial Industrial Farm Remod
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 this space and on ►he back of the white copy
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Calculate Inspeciion Fee - This Inspection Request will not 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 ONLY TOTA �
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I in ed the elechical insfallafion described herein on the dates staled
Irrigation Boom Rougifln oare
Special Inspection
F��i oa d � �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months From validafion dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection requiredZ ❑ Yes No Inspeclion Other Than RougMn: Ready Now � Will Call
(You must call the inspecfor when ready Date Ready:
I,� censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Route No.� Ciy i „
Section No. I TowosFip Name or No. �ange No. � Fire No. I County
Power
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dress (Conhacfor or Owner Performing Insfallafion) �
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:ed S' aNre �Confracfor or Own Performing Insfallafion� � p
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1 A-1 1 8/96 STATE BOARD COPY - SEE STRUCiIONS ON BACK OF YELLOW COPY