P - 79537f' REGIUEST FOR ELECTRICAL INSPECTION
Q("j ����/� � Minnesota State Board of Electricity
,�� v `t 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. Heaf Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feed
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Ge�erator INSPECTOR�S USE ONL�Y p TOTAL L,��
Sign/Outline Ltg. Xfmr. �6� �--�iC — � J
Alarm/Remote Confrol
... � r-
Swimming Pool � r
• fhaf I ins ecfed the elechical installation deuribed herein on the dates sfafed
Irrigation Boom RougMn Dar�
Special Inspection
Final D
Investigative Fee r-7:
THIS INSTALLATION MAY BE ORDERED DI CTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This requesf void 18 monlhs from validofion date prinfed in fhis box.
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PLEASE PRINT OR TYPE
Reque� � � Rough-in inspeclion required? ❑ Yes o Insp�tion Olher Than RougMn: ❑ Reody Now ❑ WiN Ca11 .
�`(ou must call the inspector when ready) Date Ready:
I, ❑ licensed conhactor owner hereby request inspection of the above elechical work at:
Job Address �Street, Box,yf Route No.� � � Ciy�� „� Zip Code �,_ _
xcnon rvo. iownsnip rvame w rv Kange rvo. rire rvo. �sounry
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Occupanf Phone No.
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Mailing Address �Contractor or
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No.
or Owner Pe ng I Ilation) Phone No�������
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STATE 80ARD COP E INSTRUCTIONS ON BACK OF YELLOW COPY