P - 79602REQUEST FOR ELECTRICAL INSPECTION °'E
`"�s V L° 316 � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 `�"
Home Duplex Apt. Bldg. Other: � `C- New Addn
Commercial Industrial Farm ,�� � e� rlt� 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. En►er remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted withou� 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 TOTAL /
$iqn/Outline Ltq. Xfmr. �( i �^�
Swimming Pool '� � `7
reb ceAi that I ins fed the eleclrical i fallafion dexribed herein on ihe dafes slafed
Irrigation Boom RougMn D �,�_
Special Inspection
final ate ! �t_
Investigative Fee Z -- �✓
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Re9 ��.� Rou h-in ins ion r uired2 es
5 g pecf eq ❑ No IospecKon Other Than Roughan: ❑ Ready Now ❑ Will Call
(You must call fhe inspecbr when ready) Dafe Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electricol work aT:
lob A dress (Street ox, or Route No.) Ciy Zip C e
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Secfion No. Township Name or No. Range No. � Fire No. Counly ^ �
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Conhacfor License
�Conhactor or Owner
or
Phone No.
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1 A 1 8/96 5TATE BOAR "'�""'" ~'�=T10NS ON BACK OF YELLOW C,O��—
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