P - 82920� REQUEST FOR ELECTRICAL INSPECTION
6 � � � � � � � Minnesota State Board of.�lectricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 "�'
me Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only
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Calculate Inspeciion Fee - This Inspection Request will not be accepied without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generaror INSPECTOR'S USE ONLY TOTAL _`
line Lt . Xfmr.
mote Confrol
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thaf I ins the elecfrical installation described herein on the dales stated
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Fee
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Investigative Fe"e' " '�' `� `j � � v `"L �
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� E USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes No inspeclion Ofher Than RougMn: Ready Now ❑ Will Call
/ (You musf call the inspector when ready� Dale Reody:
I, �icensed confractor ❑ owner hereby request inspection of the above elechical work at:
Job Ad ress (Sheet, Box, or Route No.) Ciy Zip Code
�80 �' f �U�, � ,` �
Section No. Township ame� r�o. Range No. Fire No. County � ^
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Addres
/ Conhaclw License No. Master Lic.
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C,WnPfP rm' g Insmllation� •l L-; � f1 � ' Phone�0o. —
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STATE BOARD OPY - SEE TRUCTiONS ON BACK OF YELLOW COPY