P - 82136REQUEST FOR ELECTRICAL WSPECTION `"•E
� � Z - �6 � / �A4�escta-�e B°ard of Electricity �L �
�� _/�����.CJ JT/j . 1821 Univ �[y Avenue Suite S-128, Sain� aul, Minnesota 55104-2993
�iX�.�c�.s, 0800 www.electricit state.mn.us '���
Home �/ Duplex Apt. Bldg. Other.
Commercial Indusirial Farm
Air Conditioner 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
�A'L7ECt fl.4�lc'b0e �c 2 �11 �. 7�.�30Hl�lt
New
Repair
white copy only.
��'15131/Strp Caz � � �s �' (�p
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Enhance Size Fee # Circuils J Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 2 0 to 100 Amps ],2
Street Ltg. / TraFfic Sig. Above 200 Amps Above 100 Am s
Transformer/Generator INSPEC70R'S USE ONLY TOTAL ���
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
_ I herebvi ceAifv that I inspected the electrical instollation described herein on the dates stated;
� Imestigative Fee � �
THIS INSTALLATION MAY BE ORDEI
IllIIIIIIIIfNIIIHINl�11��llll��I
* 0 9 2 2 1 1 6 9*
C �� 1 �- f�-"� �
DISCONN CTED IF_.NOT COMPLETED WITHIN 18 MONTH�'
OFFICE USE ONLY This request void 18 monfhs from validation date printed in fhis box.
! °����
��'3�
PLEASE PRINT OR TYPE
R uest Datery� Rough-in inspection required6 ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now� Will Call
�• �O•w You musf call fhe inspector when ready Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work ah
a�ia�c ovnnu �,vrr
,CC IIYJIPfY�.11V1YA V1Y ONVI� UI' i�a_���r �-����