P - 82277REQUEST FOR ELECTRICAL INSPECTION
U� J',p � r o p� � Minnesota State Board of Electricity
. 0 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
� (651) 642-0800 www.electricity.state.mn.us
Home Duplex Apt. Bldg. Other: Ne�
Commercial Industrial Farm Ren
Air C i' ner Htg. Equip. Water Hir. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whi�
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Calculate Inspection Fee - This Inspeciion Request will not be accepted withoui the correc► fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders
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 TOTALC
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dates sfa
�fflGpti011 BO001_ � Rouah-In � Date
Repair
Investigative Fee - " � J - v(
THIS INSTALLATION MAY BE ORDERED DISC D IF NOT COMPLETED WITHIN 18 MONTHS.
�— � OFFICE USE ONLY This roquesf void 18 monfhs 6om validafion date printed in this box.
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PLEASE PRINT R TYPE
Requesf Rough-in inspecfion required? ❑ Yes Inspection Other Th n Ro Mn: Now ❑ Will Ca�l
You musf call fhe inspecfor when ready Date Ready:
I, icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work ah
Job Address ISkeet,_@px, or Royt�Np.�/y �„ , � C�y � / �� Z� , � � �
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY