P - 839945�?-277 �
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Commercial
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REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
. Other: New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back
Calcula►e Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall 0 to 00 Amps to 100 A
Street Ltg./Traffic Sig. Above 200 Am s ove l OC
Transformer/Generator IN;'iPECTOR'S USE ONLY
Sign/Outline Ltg. Xfmr.
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copy only.
Fee
Alarm/Remote Control ��� S�
Swimming Pool ����� ���
I hereb certi fhaf I ins the elechical installation described herekYon the dates stated
Irrigation Boom Rough-In Dare �-
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date prinfed in this box.
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7K 0 5 3 ��G 7 7 6* PLEASE PRINT OR TYPE 75 �
Request Date Rough-in inspection required? �1es ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now�Nill Call
// �—�� (You must call fhe inspector when ready� Date Ready:
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I, �icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.� City.!_ I I Zip Code
or
Address (Contracfor or r Perh
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" ture (Confractor or Owner
/ �t/l�-
�1A-11 8/96 STATI
Range No. � Fire No.
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Installafion)
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INSTRI
Phone No.
r license No.
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Maste� Lic. No. (Plant Ele
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