P - 81502,, REGtUEST FOR ELECTRICAL INSPECTION
��'1 - 015 � Minnesota State Board of Electriciry
�f 1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104 �'
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
ir Hfg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this r uest. Enter remarks in this space and on the back of the whife copy only.
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Calculate Inspection Fee - This Inspection Reqvest 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 f�f
Sfreef Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
$ign/Outline Ltg. Xfmr. ��
Alarm/Remote Control
Swimming Pool
I hereb certi fhat I ins ected fhe elecirical installafion described herein on fhe dates stated
Irrigation Boom Roo9h-tr, Dafe
Investigative Fee — "'� � ^ Z ?_ o
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion date printed in fhis box.
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* 0 7 4 7 p 1 5 I, * 1,341�
PLEASE PRINT OR TYPE
Requ Dafe Rougfrin inspecfion required? ❑ Yes No Inspection Ofher Than RougMn: Ready Now ❑ Will Call
(You musf call fhe inspector when ready) Date Ready:
I,� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job ress (Street, Box oute No.) Ci
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Section No. Township Name or No. Range No. Fire No. County
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acror ��.ompany rvame • Contracfor License No. Master Lic. No. �Planf Elxf. Only)
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ddress (Conhact r or wner Performing Installafi� � ��
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ed Signafure onfr�fQr or Owner PerFormin I tall�n) Phone No. �
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A-1 1 8/96 S TE BOARD COPY - SEE INSTRUC ONS ON BACK OF YELLOW COPY