P - 8073382��206 �
, Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone(612) 642-0800 `�'
Other: New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this s ace and on the
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copy
Calculate Inspection Fee - This Inspection Request 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
$freet Ltg./TrafFic Sig. Above 200 Am s Above 1Q0 Amps
Transformer/Generator INSPECTOR�S USE ONLY TO
Sign/Outline Ltg. Xfmr. �•
Alarm/Remote Control
Swimming Pool
1 here0 cesTi tlwt I ins the electrical insmllrnion dascribed herein on Ihe dates staied
Irrigation Boom Rouah-In Dare
Fee
�
Final Da1 n �'� Qv
Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.., __ OFFICE USE ONLY This request void 18 mo�ths From validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE CJ JU
Reque D Rough�+n inspecfion required? ❑ Yes No Inspecfion Other Than Ro�gh-In: ❑ Ready N Will Call
� (You musf call ihe inspector when ready) Dale Ready:
I; licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.� Ciry Zip Code
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Secfion No. Township Name or No. Ranpe No. Fire No. CounN �
Occupanf
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Power Supplier
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ElecFrical Contractor �Company Name)
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ili�ress (Contractor or Owner Per(orming Insfall�
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Authwiz�,S�gpQ' ture (Conhactor or Owner P�inq In
E -11 8f96 � STATE BOARD COPY - SEE
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Phone No.
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Conhacror License No. Masfer Lic.
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CT10N3 ON BACK OF YELLOW COPY