P - 80325REQUEST FOR ELECTRICAL INSPECTION ��
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U e �� Z�� Q Q � Minnesota State Board of Electricity 3�
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� 1827 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
- (651) 642-0800 www.electricity.state.mn.us '���
tiome Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Con er Htg. Equip. Water Htc Load Mgmt Other:
Dryer Range Elee. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space
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on
Repair
of the white copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuifs / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ��
Sign / Outline Ltg. Xfmr. � L,,,Lc�(' '���
Alarm/Remote Control
Swimming Pool
. I herebvi ceAi(v fhaf I insoecfed the electrical insfallation described herein on fhe dpfes stafed:
I I Investigative Fee I I � �.�,�L�'�-------= � 7�'� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH! 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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* 0 q 2 2 2 8 8��: � 7/�
PLEASE PRINT O TYPE
R�t Dale ^� O� Rough-in inspecfion required? ❑ Yes ❑ No Inspecfion Ofher Than Rough-In• Repdy Now ❑ Will Call
�`'� You must call the inspecror when ready Date Ready:
, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
J Address �St�reet, Box, 9OUterNo.) � �� Ciy �` /} Zip �Code �
/ !/ � _
or
� Occupanf
� Power
STATF
Phone No.
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�. Master Lic. No. (Plant Elecf. Only)
i
Phone Number
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SFE INSTRIIC ON HOCK OF VELLOW COPV