P - 83165REQUEST FOR ELECTRICAL INSPECTION —
5���� Q� � Minnesota State Board of Electriciry
� � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
. Phone(612)642-0800
ome Duplex Apt. Bldg. Other: New dn
Commercial Industrial Farm Remod �.! Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X„ a ihe work covere y this request. Ente remarks in ihi�s jpace and on the back of ihe hite copy only.
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Calculate Inspection Fee - This Inspeciion Requesf will not be accepted wiihout the correci fee:
Other Fee # Se ' E rance iz Fee # ircu'rtsjFeeders
Mobile Home Park Stall to 200 m to 100 Amps �
Sheet ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S use oN�v TOTAL��
Sign/Oudine Ltg. Xfmr. ��
Alarm/Remote Confrol
Swimming Pool
I her ceAi that I ins the elechiwl insfallafion described herein on the dales sfakd
Irripation Boom R�„i,.i„ pare
THtS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE IIRE ONLY This reqwsf wid 18 months From validafion dale printed in this box.
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* � 5 3 2 4 9 4 2�c PLEASE PRINT OR TYPE
Request Date Rou ffin ins on r uired$ ❑ Yes
g pecti eq ❑ No Inspection Olher Than RougMn: �❑ Ready Now � ill Call
�� �� �You must call the inspecror when ready) Date Ready:
I, ❑ licensed conhpctor owner hereby request inspection of the above elechical work at:
bb Addreu (Shcet, Box, or Route No.) Ciy Zip Code
8/l c Cr � .�v��� c ' e �5' .3 2
SecKon No. Township Nam�� Range.No. Fire No. � C ty
li� h �
Occupant Phw�e No.
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Power Supplier � �� �� �
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Conhador
w Owner�PerFormi I�IrAb�.1 �, � Phone No. �
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STATf BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY