P - 82608� ��i� � �'� ��f REQUEST FOR ELECTRICAL INSPECTION �
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U � � 'I � � C � � �� Minnesota State Board of Electricity ���� �'
��° � U 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
• (651) 642-0800 www.electricity.state.mn.us `'�-`�
of the white copy only.
Calculote Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuifs / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ,�
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT
Sign / Outline Ltg. Xfmr. ���
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical installafion described herein on the dafes stated:
Irrigation Rough-In Dare
Special Inspection
Final Dafe
Investigative Fee ' �---�
THIS INSTALLATION MAY BE ORDERED DISCO ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months From validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Qat�� � Rou h-in ins ecfion re uired?
�T� 9 p q ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
You must call the inspector when ready Date Ready:
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo� ddr_ess tre�et`Box, or Rout No.) Ci Zip Code
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Section No. Township Name or No. Range No. Fire No. C n .
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�ress �Co acior, Co
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Signatore �C tractor,
12 5 1999
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Address
Name /
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mpa � o O�erforming Ins allation)
Com or Owner P forming Installa
STATE BOARD COPY
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License No.
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Phone Number n
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SEE INSTRUCTIONS ON BACK OF YEILOW COPY