P - 84207REQUEST FOR ELECTRICAL INSPECTION
5������ � Minnesota State Board of Electricity
. 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone(612)642-0800
Home Duplex Apt. Bidg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Hir. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of ►he white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 20J Amps Above 100 Amps
Transformer/Generator INSPECTOWS USE ONLY TOTAL !/
$ign/Outline Ltg. Xfmr. /
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Fee
Alarm/Remote Control /���
Swimming Pool
I hereb certi that I ins ted the elechical installatio� described herein on the dates stated
Irri9ation Boom Rouahan Date
Inveshgatrve re1M v v v � c�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COAlIPLETED WITHIN 18 MONTHS.
OFflCE USE ONLY This requesf void 18 monfhs from validation dafe printed in this box.
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Requesf�p Rou h-in ins tion r uired?
7%�� g pec eq ❑ Yes No Inspecfion Other Than RougMn: ❑ Reody
� � (You must call the inspector when ready) Dafe Ready:
I, [�(icensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Ad�s�eef, ox, or Roufe� / City ,. //� Zip Ca
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Secfion No. Township Name or No. Ranqe No. Fire No. CounN /
Occupant
Power
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or Owner Performing Ilation)
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Phone No.
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Cont cfor Licen_ No.
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INSTRUCTIONS ON BACK OF YELLOW COI
Lic. No.
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Call