P - 795715 VOwL��V m-
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-�800
ome Duplex Apt. Bldg. Other: New
Commercial Indushial Farm ema
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enter remarks in this space and on the back of ihe whiie copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the wrrect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Sroll 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT/�, �
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Swimming Pool — �'
I here certi that I ins electrical insrollation dexribed herein on the da�es staled '
Irrigafion Boom Ro�Mn
Special Inspection
Final
Imestigative Fee � _a-L-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN t$ MQNTHS.__
OFFlCE USE ONLY This request void 18 monlhs from validation date prinfed in this box.
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* � 5 8 � 2 5 8 2* PLEASE PRINT OR TYPE
Request Dafe Rough-in inspeclion requiredZ ❑ Yes ❑ No Inspecfion Ofher Than RougMn: ❑ Ready Now ❑ Will Call
�+�"�� (You must wll fhe inspecfor when ready) Date Ready: �
I, ❑ licensed conhactor ❑ o h�ce r uest inspection of the above electrical work at:
Job Address (Sheef, Box, or R No.) � City Zip Code
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Seclion No. Townshio Name or No. Rancae No. Fire No. Coun1Y
Phone No.
Addreu
ny Name� Cunhacwr License No. Maater Lic.
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a r PerForming InsMllaKon)
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�r or Owner Performina Instalbfionl Phone I�o'.
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BOARD COPY - SEE INSTHUCTIONS ON BACK OF YELLOW C�Y