P - 83485REGIUEST FOR ELECTRICAL INSPECTION
5. � 2��� 0 Minnesota State Board of Electricity ` " _
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-OS00
, me Duplex Apt. Bldg. Other. ,(� Q'�% L� New Addn
Commercial Industrial Farm V 0 fi , Remod Re air
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on fhe back of fhe white copy only.
Calculaie Inspecfion Fee - This Inspection Request will not be accepted wifhout the correct fee:
Other Fee # Service Entrance Size Fee Circuits/Feeders Fee
Mobile Home Park Sta�l 0 to 200 Amps 0 to 100 Amps !L
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �-7�
Sign/Outline Ltg. Xfmr. �/�G �� 6 r �c "`�v
Alarm/Remote Control � ��c� �
wimming Pool � here � thaf I ins ed the elechical insfallation deicr�h on fhe dales�tafed �
Irrigation Boom RougMn � ��7 ( _
Special Inspec ' ��
Final __ � _ 2� �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
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* � 5 3 2 5 L ��� PLEASE PRINT OR TYPE
Request /D'�ate ) ��� Rough-in inspeclion required$ ❑ Yes ❑ No Inspecfion Other Than RougMn: ❑ Ready Now ❑�II Call
J.� ( � (You must call the inspec�or when ready) Date Ready:
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I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
1ob Address �Sheef, Box, or Route No.� Ci Zi Cale
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SecFion No. Township Nam or No. Range No. Fire No. Counly
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Occupant Phone No.
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Name) � � ContracTO�
�ctor or Own r Performing Insfal � ,���
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STATE BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY
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