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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
Other: New Addn
Industrial Farm
Htg. Equ" Water Htr.
Elec. Heat
overe y this request. Enter
Load Mgmt. Other:
Temp. Service
narks 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 Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 200 Am s Above 100 Ar
Transformer/Generator INSPECTOk'S USE ONLY T��
Sign/Outline Ltg. XFmr.
Alarm/Remote Contro)
Fee
t�.0
�
Swimming Pool � � 5/� �%
I hereb ceAi ihat I ins eded the elechica insfallation described herein oh the e s fed
Irrigation Bo Rough-In - �°�
Special Insp � z- z;— Qf
Final > ° Ci
Investigative fee _{ - ` C "' /
TNic �NSTAI_LATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date prinfed in fhis box.
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* 0 4 0 0 9 1 0 6 * ~���Z
PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? es
p ❑ No Inspecfion Other Than RougMn: ❑ Ready Now Will Call
1 O� ��--L�j �You must call fhe inspector when ready� pa� R��:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.� C�h, � _ Z�P Code
.n _ �. . �
or
��T C..l.ilNl
Power Supplier
� ��
or
• �
Fire No. Coun(`
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Phone No.
Conhador License No. Master Lic No. �Nant
� ��C'!s
�t�1 Phone No.
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY