P - 82309REQUEST FOR ELECTRICAL INSPECTION ������-
8������ � Minnesota State Board of Electricity
r 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 this request. Enter remarks in this space and on ihe back of the white copy only.
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Calculate Inspection Fee - This Inspec�ion Request 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
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ~ o/ ��
Alarm/Remote Control
Swimming Pool I hereby certi(y thaf I inspecfed the elechical insfallafion described herein on the dates slated
Final Uafe
Investigative Fee `�D "d�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ OFFlCE USE ONLY This roquest void 18 months kom validation date printed in this box.
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* 0 8 2 6 2 1 4 9* 5"ft�7
PLEASE PRINT OR TYPE
R�sf �—� Rough-in inspecfion required$ ❑ Yes No Inspecfion Ofher Than Rough-In: Ready Now � Will Call
� (You musf call fhe inspector when ready� Da}e Ready:
I, licensed confractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Addreu �Street, Box, or Route No.� Ciy Zip Code
� �'`_ Gn �i�l�
Secfion No. Towns p Name or No. Ranpe No. Fire No. CounN
Phone
��� 28
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cfor (Company Name) � Con}ractor License No. Masfer
�'ii1�/�1�ts.� ���Lr% � Q � 4 � /��_
�Conhactor or Owne Performing Installafion�
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY