P - 83542REGIUEST FOR ELECTRICAL INSPECTION s
7�� '-F - 6 6 6� Minnesota State Board of Electricity
�� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �;
2 �� Phone (612) 642-0800 "�'
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial 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.
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Calculate Inspection Fee - This Inspection Request will not be accepted 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
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Genefator INSPECTOR's use oN�v TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control `5 �
Swimming Pool
I hereb ceAi that I ins the elechical in ilation described herein on the dates stafed
Irrigation Boom r RougMn ��
Special Ins � ` �
� re
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECT'ED IF NOT COMPLETED WITHIN 18 MON HS.
OFFCE U8E ONLY This req�est void 18 months hom validation date printed i� this box.
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*07246663* ��a9
PLEASE PRINT OR TYPE
. Request Date Rough-in inspecfion required? ❑ Yes o Inspection Odter Than Rough-In: ❑ Ready IVow dl CaN
�You musf call fhe inspecfor when ready� Date Ready:
I, icensed contractor ❑ owner hereby request inspecfion of the above elechical work at:
Job Address (Sheef, Box, or Route No.� � r r City � � Zip Code
Section No. �'fownship Name or No. � Range
�
Conkacfor �Company Name)
Phone No.
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��n�f�\ec�. �o��. Co. I 1;�00�O10 I -
�ress �Conhacfor or Owner Performing Insfallafion�
8+a, .e�.+ �� � Pau I n� N� � o�
Si� onhacfor or Owner Performing I stallalion) - Phone N�oj
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��$�I6 s STATE BOAR COPY - SEE INSiRUCT10NS ON BACK OF YELLOW COPY