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REQUEST FOR ELECTRICAL INSPECTION �—�
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Other: New Addn
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspecfion Requesf 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
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfinr. Q •�
Alarm/Remote Conhol
Swimming Pooi
I hereb certi that I ins the eleclrical installallon dexribed herein on the dafes sfated
Irrigation Boom RougM� �+e
Special Inspect `� ^' ":
final Dafa
Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED DISCO TED IF NOT COMPIETED WITHIN 18 MONTHS.
OFFlCE USE ONIY This request void 18 months from validation dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rougfrin inspecfion requiredZ ❑ Yes No Inspection Olher Than Rou h-In:
_�h w g ❑ Ready Now Will Call
�� ••-[.� (You must call fhe inspecfor when ready� Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Street, Box, or Rou�e No.) Ciy Zip Code
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Section No. Township Name or No. Ranqe No. Fire No. Cou N
� Mailing Address
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Na �
HT�. A,C ELECT., iNC.
Phone No.
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License No. Master tic. No.
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6-� -.�«.. ..�IA7.E$OARp�COR1G � SEE INSiRUC710NS ON BACK OF YELLOW COPY