P - 80999REGIUEST FOR ELECTRICAL INSPECTION
8��- 8 3 9� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paui, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
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 the back of the white copy only.
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Calculate Inspec ion Fee - Thi Inspe on Request will not be accepted wilhout 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 T� �j`
$ign/Oudine Ltg. Xfmr. ' � �J
Alarm/Remote Confrol
Swimming Pool
I hereb cerfi that I ins the electrical installation dexribed herein on the dates stated
Irrigation rli �"" RougMn Dare
Special Ins ct n
Final �ate.^�J'. 7 7_�+./
Investigative Fee O �4J C
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Reque�t`/� � Rough-in inspection requiredZ ❑ Yes o Inspection O�er Than RougMn: ❑ Ready Now ill Call
�You must call the inspector when ready� Date Ready:
I, icensed contracior ❑ owner hereby request inspection of the above electrical work at:
Job dd heet, Box, or Route No.� Ciy Zip Code
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Section No. Township Name or No. Range No. . Fire No. Coun ��a /,
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Occupani �� � Phone No.
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Power Supplier Adc�@SS,/� /f�� �� ��
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Elec ' om me� Lon cror Licgn�No._�� Master Lic. No. (Plant Elect. Only)
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Ma" dr s(Contr or Owner PerFormin fallafion�
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Authorized na e(Co r or ner e g Installation) � e N.'// /�
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E&00001 8/96 STA E BOARD COPY - SEE INSTRUCTIONS ON_9ACK OF YELLOW COPY