P - 83905( REQUEST FOR ELECTRICAL INSPEC�iON
5 4 U,,' � 1 2 g Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. P,aul, MN 551�
s Phone(612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmf. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work cover'by this request. Enter remarks in this space and on the back of the white copy c
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Calculaie Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance ize Fee # Circuits/Feeders
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA ��
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that � i�s ected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In pa�
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Fee
Final Dat G�
Imestigative Fee - t °- �� a3/ l%
_THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validation date printed in this box.
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* � 5 4 �]i 2 8 � 7k PLEASE PRINT OR TYPE �'S'�
R 1 r�i ") Rou h-in ins tion r uired? ❑ No Ins ection Other Than Rou h-In:
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ou must call the ins tor when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
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Section
Occupant
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dress �Conhactor or Owner Performing Installation�
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Signature (Conkocior or Owner Performin nstalla
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1 1 8/96 STATE BOARD COPY •
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Phone No.
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License No. � Master
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