P - 83947REQUEST FOR ELECTRICAL INSPECTION '
5 � �� � � � � � 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 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 Inspeciion Fee - This Inspecfion Request will n be acc�
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 to 200 Amps
Street Ltg./Traffic Sig. Above 200 Amp
Transformer�Cienerator INSPECTOR'S USE ONLY
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
�h t the correci fee:
Fee # Circuits/Feeders
0 to 100 Amps
Above 100 Amp:
TOTAL
I hereb certi that i ins fed the elecfrical insfallafion described herein on the dafes stated
Irrigation Boom RougMn Date
Special InsoectiaC� r- � r
�
Fee
THIS INSTALLATION MAY BE ORDERED DISCZ)NNEt.`TED IF NOT COMPLETED WITHIN 18 MON'fHS.
OFflCE USE ONLY This requesf void 18 monfhs from validafion date prinfed in fhis box.
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Reques Date Rou h-in ins fion r uired?
�� s�y--�— �� � g pec � ❑ Y�) No Inspectio� her Than Rough-In: ❑ Ready Now ill Call
ij� /� ou must call the ins or when rea Dafe Rea
I, �ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addr ss eef ox, or Ro fe No.) Cify � / - Zip Code
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Secfion No. Township Name or No. Range No. Fire No. Coun �
Occupant
Owper
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Phone No.
Atltlress �/�� //`�Cr'/ L- � / '
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Con cfor licer�e_�lO�� Masier Lic. No.
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ning Ins n)
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R COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY