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Home Duplex
Commercial Industrial
ir Htg. EquiF
Dryer Range
"X" above the work covered bv
„ REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity `:�
1821 University Ave., Rm. S-128, St. Paul, MN 55104 _
Phone (612) 642-0800 `���
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this requesi. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Requesi will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 i
Transformer�Generator INSPECTOR'S USE ONLY T
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Poo{ I he�eb cerfi thatl ins ttw� the elechical installation described herein on the�
Irriqation Boom R,,,,,,ti_i„ �,,.e
Fee
imestigative r� � v- s �- � v—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_. � � OFFICE l�E ONLY This request void 18 months from validation date prinfed in fhis box.
� lil� �� ��I �� �!� II ��� �� ��I �� ��I�I ��� �) � �(� • a° "�
� D 8 2 6 0 9 9 4* �3l�
PLEASE PRINT OR TYPE
Request D � Rough-in inspection requiredZ ❑ Yes o Inspeclion Other Than RougM . Ready Now � Will Call
�You musf call the inspector when ready) Dafe Ready:
I licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job`�x, or R\e�.' �/l� 11 U 771�1 Ciy '1 1�►� l� Z' ./G�
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