P - 80641�.
• REQUEST FOR ELECTRICAL INSPECTION
��C� �, �� �� � 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
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Fitr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy
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Calculate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee:
Other Fee # Serv' Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 20 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT,
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimminq Pool
Date
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Fee
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Investigative Fee "` �-(v. � � /—�,� �%
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS�
OFfICE USE ONLY This requesf void 18 months kom validafion date prinfed in fhis box.
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PLEASE PRINT OR TYPE
�quest D Rou h-in ins ection re uired? Yes
g p q ❑ ❑ No Inspection Other Than Rough-In: Ready Now � Will Call
�You must call the inspector when ready) Dafe Ready:
licensed contractor ❑ owner hereby request inspection oF the above elecfrical work at:
6 Ad ess„(S� t, Box, &oute No.� � Ciy , � Zip Code
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rtion No. Township Name or No. Ronge No. fire No. Couny �
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Moiling Address �Contracror or
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for mg Installafion)
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Phone No.
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A-1 1 8/96 ST/�y ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY