P - 846304.6�y-649
RE(IUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other:
Commercial Induslrial Farm
Air Cond. Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by Ihis request. Enier remarks in this space and on
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Lig./Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA�%
Sign/Oudine Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool .
I hereb certi that I ins the elechical inztallation described herein on the dates stated
Irri9ation Boom RougMn Dare
Special lnspecti _
Investigative Fee F��� -��_---��- �^ Z C�"--
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monlhs (rom validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes o Inspection Othe �Tha Roug n: eady Now ❑ Will Cal)
(You must call the inspecror when ready� Date Ready: � j
I, � ensed contractor ❑ owner hereby request inspection of the above electrical work at:
hb Address �Skeef, Box, or R le .) City Zip e
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Section No. Township Name or No. Range No. Fire No. Coun /) /
Occupant
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