P - 80813REGIUEST FOR ELECTRICAL INSPECTION
8�s� .� �� Q Minnesota State Board of Electricity
-� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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' Phone (612) 642-0800 '�'
Home Duplex Apt. Bidg. Other: New Addn
Commercial dustrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other.
bryer 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 Re st 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 oN�r TOTAL
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool Ow
I hereb certi thot I ins ted the electrical installation described herein on the dates stated
Irrigation Boom RougMn Dare
Special lnspec
Investigative F F� � O �
THIS INSTALLATION MAY BE ('JRDERED 91SC ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONIY This request void 18 monihs from validation date printed in fhis box.
I IIII II III II III If fll {I IN N�N1f II Iil II Ifl I •����/
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* 0 8 3 4 0 1 9 2� �70 `F'
PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspeclion required? ❑ Yes ❑ No InspecEon Other Than RougMn: Ready Now Q Will Call
.� • g �You musf call the inspecfor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address �Shcet , o Roure No.� Ciy Zip Code
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$ection No. Township Name or No. Ranae No. Fire No. Coun _ _�
Occupanf
Powef SupF
Phone No.
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t��h,�a� �����:.�m�6YLEmeELECTRIC, I NC. Confractor License No. Master Lic. No. (Piont Elecl. Only)
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Mailing A ress a r • r' I
•on �`apids, MN 55433
Authorized Signature �Contr r Owner Performing Ins lation� Phone No. q
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EB-OOOOlA-11 8/96 BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY