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RE(�UEST 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. Other: New Ad�
Commercial Indushial Farm Remod Re
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service �
"X" above the work covered by ihis reqvest. Enter remarks in this space and on the back of the wh' opy only.
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Calculate Inspec�ion 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
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�r TOTAL � �
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool �y G-`F�j'
I hereb certi that I ins fhe elecfrical insfallation deuribed herein on the dales stafed
Irrigation Boom Ra„9F,�„ Dare
Special Ins
Investigative �� �` � � - Z — i
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
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* O 4 3 O S L O 8* PLEASE PRINT OR TYPE
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g peclion required2 ❑ Yes o Ins ion Olher Than Rou Mn: Rea Now
� 9 dy ❑ Will Call
(You musf call fhe inspector when ready) Dafe Ready:
I, �licensed conhactor ❑ owner hereby request inspection of the above elechical work at:
.bb Addreu (Shcet. Bou, or Rou1e No.) Ciy C Zip Code
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'on No. ownship ame or No. Range No. Fire No. Counfy
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Occupant
Phone No.
Conhacfor
r �`eG�'Y
or Owner Perfom
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No. Ivlasfer
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BOAR[1 COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY