P - 80695REGIUEST FOR ELECTRICAL INSPECTION
��J J- 2 01 � Minnesota State Board of Electricity
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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 Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other; /
Dryer Range Elec. Heat Temp. Service ��
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted wiihout ihe correct fee;
Other Fee #.Service Entrance Size fee # Circuits/Feeders
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Streef Lfg./Traffic Sig. bove 200 Am s Above 100 Amps
Transformer/Generato� .__ iNSPecroR'S USE ONLY �� �v�� TOTAL
Sign%Outline Ltg. Xfmr. ��� $1'�� (iC � � �
Alarm/Remote Control �d1 /�� � n9' ° "'�`"" �
Swimming Pool
I herebvi cerfifv that I insoected the elechical inslallafion described herein on the dates stoted
Investigative Fee < � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OPFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request te Rou h-in ins on r uired$ ❑ Yes
g pecli eq ❑ No Inspeclion Ofher Than RougMn: Ready Now ❑ Will Call
'� D `� 9 (You must call the inspec�w when ready) Date Ready:
I, censed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Street, Box, or Route NoJ Ciy Zip Code
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Secfion No. Township Name or No. Ranoe No. Fire No. CounN �. .
Occupanf f� ' � n . IPhone No.
Power
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RI�. I��. Contrac�or License No. Master Lic. No. (Plant Elecf.
3 rr�c'
e�r�ing nsfallafion) � �� � � �
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1 8/96 ST OA D PY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY