P - 78825REGlUEST FOR ELECTRICAL INSPECTION = ��.
� 4 2= 9 6 6 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paui, MN 55104
Phone (612) 642-0800
Home Duplex � Apt. Bldg. Other: ' New Addn
Commercial Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
„X"� 6=v�e�cove��� i� � quest Enter r�a�s in this space an on� back of�e white copy only.
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Calculate Inspection Fee - Th�s Inspection Requesf will not be accepted without fhe correct .�,/C?
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's uSE ON�v TOTA�D. �r---h
Sign/Oudine Ltg. Xfmr. � ��
Alarm/Remote Conhol � � �
Swimmiog Pool
I hereb certi that I in Ihe electricol installation described herein on the dales stated
Irrigation Boom RougMn p�e
Special Inspec:tion
Finol oere
investigative Fee � - —�'
THIS INSTALLATION MAY BE ORDERED qSCONNECTED IF NOT COMPI.ETED WITHIN 18 MONTHS.
OFRCE l/SE ONLY This request void 18 months from validation dafe prinled in ihis box.
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PLEASE PRINT OR TYPE
Request Da Ro h-in ins on uired?
�,/� u9 pecti req ❑ Yes No Inspection Olher Than RougM�: Ready Now ❑ Will Call
�� " �/ (You musf call the inspec�or when ready� Dafe Ready:
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
b Addre� Sheet, Box, w Route No.) Ciy� � Zip Code
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Seclion No. ownship ame a No. Range No. fire No. Coupry
Occupanf ,�
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Po�ver Suppha� -� pddress
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����� Masler Lic. No.
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COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY