P - 8348153�-502
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REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-08 0
Other. � � New Addn
d R
Commercial Industrial Farm Remo e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
above the work covered by this request. Enier remarks in this space and on the back of ihe white copy only.
Calculate Inspection Fee - This Inspection Request will not be
Other Fee # Service Entrance '
Mobile Home Park Stall 0 to 200 Amps
Street Ltg./Traffic Sig. Above 200 �
Transformer/Generator INSPECTOR'S USE ONLY
$ign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
1 hereb certi ihat I ins the elechi insMllation described herein on the dates sfated
�rrigation Boom RougMn `�/� ��_'� —
Speciall i t ��
Final
ImestigaY e " . r
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf wid 18 months from validafion dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Request Dafe
Rough-in inspecfion required2 es ❑ No Inspecfion O�er Than Rough-In: ❑ Ready No Will Call
r � (You musf call ihe inspector when dy) pafe Ready:
I, ❑ licensed confractor owner hereby request inspection of the above electrical work at:
Job Add es Sheet, Box, or R ufe No.) City Zip Code
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Section No. Township Name or No. Range No. Fire No. Counly���
�a . �s�
without the correct fee:
=ee # Circuits/Fe
0 to 100 Amps�
Above 100
I 1 Power
dross (Co�fOr or Owner Performing Ins
J �}'12�
Signatu e onh r or Owner Performir�
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11 8/96 STATE BOARD
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INSTR
Phone No.
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Conhacfor License No. Master Lic. No.
No.