P - 79600_���-317 �
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone(612)642-0800 "�'
Apt. Bldg. Other: --�l New Addn
Farm , �v Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stcall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Am s Above 100 Ai
Transformer/Generator:'' ' iNSPeCTOR�sus�p NLY TOT
Sign/Outline Ltg. Xfi�r. /,�� „L � � � o �
AI.._�/D_�_a_!`__� . I w ��
Fee
I�
i
Swimming Pool '� j �
I hereb ceAi thm I ins the el ' I insfallation described herein on the dates slated
Irrigation Boom RougMn Da
Speciallnspection �Q� �
Firwl � ^ � 2
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 1 MONTHS.
OFHCE USE ONLY This request void 18 months from validation date printed in this box.
I�III II III II �I� I) III II I�I II II) II III II ��� I�I
* 0 8 0 2 3 1 ? � � � �� �/�S �
PLEASE PRINT OR TYPE
Reque� � Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough•In: ❑ Ready Now ❑ Will Call
(You must call the inspec�or when ready) Date Ready:
I, ❑ licensed contractor�owner hereby request inspecfion of the above electrical work at:
bb Address (Streef, Box, or Route No.l CiN Zip Code
No. I Township Name o�lo. ,
�JCJ �w
(Conhac�or or Owner
or
Fire No. � Couny �� �
Phone No.
No.
mrv
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY