P - 847384��7-225
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REf�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
New
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Commercial Indushial Farm Remod
Air Cond. Hig. Equip. Water Hir. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter r arks i� this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Trar'fic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ��
Sign/Outline Ltg. Xfmr. �J
Alarm/Remote Control
Swimming Pool
t hereb certi that I ins ted the elechical insMllation described herein on the dates sta�ed
Irri9ation Boom Rough-In Dare
Investigative F�ii � �- r��ai �__---� `---�-----_ I U�� �l C�
THIS INSTAL ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 M THS.
OFFICE USE ONLY This request void 18 months from validafion date prinled in this box.
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* 0 4 5 7 2 2 5 L�K PLEASE PRINT OR TYPE �� -� ��
Reques� �� Rougf�in inspection required8 ❑ Yes o Inspeciion O�er Than RougMn: eady Now 0 Will Call
(You must call the inspecfor when ready) Dofe Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
I/���r�c/ �1, Bo , or oute ��� Ciy �� Zip Code
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Secfion No. Township Name or No. Ranpe No. Fire No. ounty .
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