P - 82399� REQUEST FOR ELECTRICAL INSPECTION
��� �(� Q('� � Minnesota State Board of Electricity
V(.� V 1821 University Ave., Rm. S-128, St. Paul, MN 55104
r Phone (612) 642-0800 ���
Home Duplex Apt. Bldg. Other�a � New Addn
Commercial Industrial Farm � �'2� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enter remarks in thi space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepied without �he correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps �Qli
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use ON�v TOTAL
Sign/Outline Ltg. Xfmr. ...�
Alarm/Remote Control Q�, ��
x �,"
Swimming Pool G �
I hereb cerfi fhat I ins fed fhe elechical insfallation described herein on the dafes sfaTed
Irri9ation Boom RougMn pa�
Speciallnsp i
� Final pa '
Investigative Fee Z�E'�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ OFFICE USE ONLY This request void 18 months from validation dafe prinfed in this box.
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* 0 6 7 6 0 8 0 5* b� � �'�1 /
PLEASE PRINT OR TYPE
R st Date / Rough-in inspeclion requiredZ ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now Will Call
ff � �(You must call the inspecbr when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electricol work af:
Job Add ss Sheet, Box, or Route N � Cify ' Zip Code
d� l �/1� `� r� l �
Section No. Township Name or No. Ran e No. Fire No. Cou
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Power $upplier Address
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or Vwne Yertoiming Instal
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Phone No.
Conhacror License No. Master Lic. No.
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11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY