P - 82398REQUEST FOR ELECTRICAL INSPECTION
8�,� ,� ��� � 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 Addn
Commercial Indusfrial Farm �� �- Remod Re air
Air Cond. Htg. Equip. Water Htr. 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 white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY � � % TOTA
Sign/Oudine Lfg. Xfmr. ��� �. �/Z �� T S�G Di S�
Alarm/Remote Confrol �� � �
Swimming Pool
I hereb certi that I ins the electrical installafion described herein on ihe d
Irrigation �fjF� � A Rouah-In Dafe
Investigative Fee p�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 monifis from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Request Do Ro Irin ins ion r uired2 Yes
� ug pecl' eq ❑ No Inspeclion Olher Than RougMn: ❑ Ready Now � Will Call .
(You musf call the inspector when ready� Date Ready:
I, ❑ licensed contractor L�J owner hereby request inspection of the above elechical work at:
Job Addreu �Sheet, Bo^, or Route No.� Ciy t Zip Code
► �� �d� L7 ,�, z
ecfion o. Township Name or No Range No. Fire No. C ly � �
� Occupant
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Mailing Address (Conkactor or Owner Performing Installation)
Authorize� ' (Conho�ryor or erforming Instalhfion�
Phone No.
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Conhacror L cense No. Master Lic. No. �Planf Elecl.
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BOAAD COPY - SEE 1MSTRUCTIONS ON BACK OF YELLOW COPY
No.