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REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55704-2993 ��
(651) 642-0800 www.electricity.state.mn.us "�'
Home Duplex Apt. Bldg. Other: New dc
Commercial Indusirial Farm Remod Rep
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy only.
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Calculafe Inspection Fee - This Inspection Request will not be
Other Installafions fee # Service Enhance Size Fee
Mobile Home Park Sfall 0 to 200 Amps
Street Ltg. J Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Conhol
�pted without the correct fee:
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
I herebvi certiH that I inscecfed the electrical installation described herein on the dMes stated:
Final /�' �f D��� �
Investigative Fee ( °-- �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1�8 months from validafion date pr'n�ed in this box.
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PLEASE PRINT OR TYPE
R st ate Rough-in inspection required8 Yes ❑ No Inspection Other Than Rouglrin: ❑ Ready Now�"7�ill Call
� ��/� You must call fhe inspector when ready Date Ready:
I,�'ficensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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SEE INSTRUCT10N5 ON BACK OF YELLOW COPY