P - 82963_ . �
OFFICE USE ONLY This request void 18�s from validafion dafe printed in fhis box.
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P EASE PRINT OR TYPE
Request 'L A '�� Rou h-in ins ection re uired?
g p q ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�� / (�ou musf call the inspectcr when ready� Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Ad `ess (S eef, Box, or ute No.) /� � City � Zip Code
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Secfion No. Township Name or No. Range No. Fire No. C nty /
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Occupanf ' Phone No.
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SEE MISTRUCTIONS ON BACK OF YELLOW COPY
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REQUEST FOR ELECTRICAL INSPECTION —
C{� �,� C C 7 Minnesota State Board of Electricity
C;�J �J J 1 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Reoair
Air Cond. Htg. Equip. Water Htr,
Dryer Range Elec. Heat
"X" above the work c ered by this re uest. h
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Mgmt. Other:
Service
in this space and on fhe back of the white copy
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Calculate Inspeciion Fee - This Ins cfion Request will not be accepfed wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feed�
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY TC
Siqn/Outline Lta. Xfmc
� Pool
I hereb certi that I ins �e electrical installation described herein on the dales slated
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� Investigative FeFiI V t7� � V � f` � V
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18
Fee