P - 84685RE(�UEST FOR ELECTRICAL INSPECTION '
5 O f1 „(] O O Minnesota State Board of Electriciry
�1} J 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
ommercial Industrial Farm Remod
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 ►his space and on the back of the white copy only.
CL�� �-+ �,�
Calculate Inspection Fee - This Ins <
Other Fee
Mobile Home Park Stall
Sheet Ltg./Traffic Sig.
Tra n sformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
S ' P I
�n Request will no► be accepted without the correct fee:
# Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100 Amp:
INSPECTOR'S USE ONLY TOTAL
wimming o0
I hereb certi that I in the electrical inslallafion described herein on the dates sMted
Irrigation Boom RougMn �a�
$pecial Inspec' �
Final � ,. _ -- ,_zL�
Investigative F
THIS INSTALLATION MAY BE ORDERED DtSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
— —irns ----------- ---- -------
OFFICE USE ONLY This rsqueat void 18 months 6om validaticn date printed in fhis box.
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�k O 5 O D�J O O 6* PLEASE PRINT OR TYPE
Request Date —^ Rough-in inspection required2 ❑ Yes ❑ No Inspection Olher Than RougMn: eady Now � Will Call
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� 1 (You musl call the inspector when ready) Dale Ready:
f, censed confractor ❑ owner hereby request inspection of the above elechical work at:
Job Address �Sheet, Bo , or Rou .) C' Z�P C�e
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vl.y �
_..retr,� No_ Townshio Name or No. Range No. Fire No. CaQ�Y n ��
Power
0
Phone No.
�I � - �g?�
License No. Master Lic. No. (Plant
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Au .ature (Conhactor or Owner � g Installation� . 5 2 � � � �js �`JV' •
E 1 A-11 8/96 ST BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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