P - 81494.
730-526
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Othgr� �� New ddr
Commercial Indushial Farm 1� Remod Re a
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this request. Enter remarks in ihis space and on the back of ihe white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPEC70R°S USE ONLY TQ ��
Sign/Outline Ltg. Xfmr. �/
Alarm/Remote Control
Swimming Pool
I hereb certi fhat I ins fed the elecfrical insfallafion described herein on the dafes staled
Irri9ation Boom Rough-In Dare
Speciallnspecd t -� - � %�
� Final Date
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf fe Rouglfin inspecfion required? es
❑ No InspecNon Olher Than RougMn: ❑ Ready Now ill Call
S� (You must call the inspector w en ready� Date Rea�y:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob�Sheet, Box, or o.� r Ciy Zip Code
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Secfion No. Township Name or!
Occuponf
Power Supplier ` �
Electri Conhatlor �Company Nai
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Range No. � fire No.
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Performing
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Phone No.
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Pbone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COVv