P - 82938.
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Commercial � � Industrial
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
i821 University Ave., Rm. S-i28, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other: New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
"X" above the work covered by this requ . Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Requesi will not be accepted without the correci fee:
Other Fee # Service Entrence Size Fee Circuits/feeders
Mobile Home Fark Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elechicol installation deuribed herein on the dah
Irrigation Boo ��} r, RouaMn Dare
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Fee
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Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
III�` II � I OFFICE USE ONLY This request void 18 monfhs from validation date printed in fhis box.
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P EASE PRINT OR TYPE
Request '�� Rough-in inspection required? ❑ Yes No Inspecfion Other Than RougMn: Ready Now � WiN Coll
�� (You must call the inspector when ready) Date Ready:
I, �ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job d Sheet, Bo� ute .) City , Zip Code
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$ecfion No. Township ome or No. Range No. Fire No. Cou
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Occupant � � � . Phone No.
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Con cfor Liuns ��� Masfer Lic, No. �Plant
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or Vw er P rmi afj.�n�� � � P��i/ I�
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T BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY