P - 82232-- R,FQUEST FOR ELECTRICAL INSPECTION
8 O�� L o/I � Minnesota State Board of Electricity a
'"r 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
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 this space and on the back of the white copy only.
Calcula►e Inspection Fee - This Inspection Request will not be acce
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 to 200 Amps
Street Ltg./Traffic Sig. Above 200 Am
Transformer/Generator INSPECTOR'S USE ONLY
$ign/Outline ltg. Xfmr.
A1 /R t Cont I
without the correcf fee� � � �
Fee # Circuits/Feeders
0 to 100 Amps
Above 100 Amps
Fee
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arm emo e ro
Swimming Pool � �-2�/-' �U
I hereb certi that I ins the electrical i Ilation descri rein on the ales sfated
Irrigation Boom � RougMn
Special inspection .�' '� f �"� da
Final
Investigative Fee � 26�d
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs From validafion date prinTed in this box.
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PL SE PRINT OR ��
Request fe � RougMin inspection required? Yes o Inspecfion Ofher Than Rough-In: ❑ Ready Now � Will Call
� .� �� (You must call fhe inspecfor when ready) Dafe Ready:
I, ❑ licensed contractor �wner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Roufe No.) City Zip Code
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$ecfion No. Township Name or No. Range No. Fire No. CounN
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T«
d Confmctor (Company Nam
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Address (Conhacror or Own�
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InsMllaTion�
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Phone No.
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License No. � Masler Lic. No. (PhM
(Conkoclor or Ow �r Pe rming InstallaTion) Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY