P - 83777REQUEST FOR ELECTRICAL INSPECTION
4 4.� � p� Q � Minnesota State Board of Electricity
0 � t8�1 University Ave., Rm. S-128, St. Paul, MN 55104
r Phone (512) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
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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 Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Se 'ce Entrance ' e Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps � 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT��,A� �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control � ,..
SwimmingPool �l � �������
I hereb certi thai I ins fed fhe electrical insfallafion dexribed herein on the dates stated
Irrigation Boom Rough-In /"\. 4� � Dare
Special lnspecti � '
Investigative Fee � Final y ��
THIS INSTALLATION MAY BE ORDERED DISCO TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 R monfhs from alidafion dafe pri d in ihis box.
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PLEASE PRINT OR TYPE
Request D Rou h-in ins ection r uired? es
g p eq ❑ No Inspection Olher Than Rough-In: ❑ Ready Now Will Call
�� (You must call the inspecfor w n r dy) Dafe Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.� Cify Zip Code
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Section No. Township Name or No. Range No. Fire No. Cou� I �
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Elecfrical Conhactor �Company ame)
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Phone No.
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No. Master Lic. No. (Plant Eleci. Only
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OF YELLOW COPY