P - 83198REQUEST FOR ELECTRICAL INSPECTION
6 -7, Minnesota State Board of Electricity
3•� - 2 2 9� 1821 University Ave., Rm. S-128, :St. Paul, MN 55104
f � Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
Air Cond Htg. Equip. Water Hir. Load Mgmt. Other:
ryer 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 Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimminq Pool
rn Request will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits/Feeders F e
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100 Amps
INSPECTOR'S USE ONLY TOTAJCL� �
that I ins �e electrical insfallafioo described herein on ihe dates
Date
Final ^�� ij�
Investigative Fee l �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFF�E USE ONLY This request void 1@ monihs 6om validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Roughin inspeMion required$ ❑ Yes ❑ No Inspecfion Olher Than Rough-In: Re�
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•%� �You must call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sfreef, Box, or Route No.) Cily Zip
/O L � �
Secfion No. Township Name or No. Range No. Fire No. Coun
Occupanf
Power
DEPENDA
C�an Rap'.
Authorized Sipnc
� � Phone No. _ Q �
Address
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Ig�r�J�'�. ��� Coniractor License No. Master Lic. No
u � /'��cC
�'��� �,� ��5ro���o�i
or Owner Performing 1 Ilafion) �. Phone No.
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A E BO RD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Now � Will Call
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