P - 80970• • � •
• • •
REQUEST FOR ELECTR(CAL (NSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mg t. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the bpck of the white
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Calculate Inspection Fee - This Inspection Request wi I not be accepted witf�o" ut tl�e correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feedei
Mobile Home Park Stall 0 to 200 Amps ,3 p°,, 0 to 100 Amps
Street ltg./Traffic Sig. Above 200 Amps Above 100 i
Transformer/Generator INSPECTOR•s use oN�v TO
Sign/Oufline Ltg. X �-Ca.(�t.� • �•
Alarm/Remote Co I _ _
Remod
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Fee
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Irrigafion Boom Rough-In �r�
Special Inspection
Final
Investi ative Fee � � �'--
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ OFFICE USE ONLY This request void 18 months from vatidation dafe printed in fhis box.
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PLEASE PRINT OR TYPE ��
Request Date Rough-in inspection required$ ❑ Yes �o Inspection Other Than Rough-In; �dy Now ❑ Witl Calt
Lt �. a` Q �You must call the inspecfor when ready) DaM Ready:
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I, ensed contractor ❑ owner hereby reques� inspection of the above electrical work at:
Job Address �Sfreef, Box, or Roufe No.� City Zip Code
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STATE BOARD
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E INSTRU BACK OF YELLOW COPY