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Home Dupler
Commercial Indusfr
Air Cond. Htg. Ei
Dryer Range
"X" above the work coverec
RE(�UEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, S2. Paul, MN 55104
Phone(612)642-0800
Other: New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on
Remod
of the white copy only.
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Calculate Inspection Fee - This Inspection Reques► will no► be accepted wiihout the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�S usE oN�Y TOTyAL
Sign/Oudine Ltg. Xfmr. � -`� ' �
Alarm/Remote Confrol
Swimming Pool
I hereb certi fhat I ins ted the elechical installation described herein on the dafes sfated
Irrigation Boom Rough-In Date
Special Inspectio p � �
Finol
Investigative Fee -
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� i OFFlCE USE ONLY This request void 1 S moMhs from validaticn date printed in this box.
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* 0 5 1 9 � 3 2 7* PLEASE PRINT OR TYPE /�f �
Requesf �Djte j Rough-in inspecfion required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call
`� 1 it J,� �—� � (You must call fhe inspector when ready) Date Ready:
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f, (�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Streef, Box, or�te No.) Ci Zip Code
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I Secfion No. Township Name or No. Range No. Fire No. Co �ty �
c;�
Address
IConhacior�Company Name)
BLAINE HTG. A/C ELECT., ING
Address I r s n)
License
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Phone No.
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Masfer Lic. No. (Planf
or Performin Mltallation� �� � I Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY