P - 82596REQUEST FOR ELECTRICAL INSPECTION ���
� � � � 'I � (� 5 Q � Minnesota State Board of Electricity �'
� 1 J v 1821 Universiry Avenue SuiFe 5-128, Saint Paul, Minnesota 55104-2993
r� (651) 642-0800 www.electricity.state.mn.us `���
Home Duplex Apt.8ldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg, Equip. Wafer Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi fhat I
Irrigation Bo a Ro� h-In
9
Special Inspection — '"
Investigative Fee ��I
THIS INSTALLATION MAY BE ORDERED
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the electrical installation described herein on the dates stated:
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DIS NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 8 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes ❑ No Inspecfion Ofher Than Rough-In: eady Now ❑ Will Call
You musf call the inspector when ready Date Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspettion of the above electrical work at: