P - 82046, REQUEST FOR ELECTRICAL INSPECTION
U� � � � � � � � � Minnesota State Board of Electricity
- 1821 University Avenue Suite 5-728, Saint Paul, Minnesota 55104-2993
` (651) 642-�800 www.electricify.state.mn.us
Home Duplex Apt. Bldg. Other: Ne�
Commercial Industrial Farm en
Air Condifioner Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Range Elec. Heaf Temp. $ervice
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the whii
copy
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Panel Change 1 branch circuit y Z%�� ��'�/ /,� �
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Calculate Inspection Fee - This Inspeciion Request will not be
Other Installafions Fee # Service Entrance Size Fee
Mobile Home Park Stall to 0 Amps
Street Ltg. / Traffic Sig. Abov 200 Amps
Transformer/Generator INSPECTOR'S USE ONIY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
— I hereb certi that I ins ected the elecfrical installation
Boom Rough-In
� Investigative Fee � �
THIS INSTALLATION MAV BE ORDERED
... ..: I�NII�N���A�.IInII���III�
* 0 8 8 6 7 7 4 9*
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� without the correct fee:
�ircuits / Feederr Fee
0 to 100 Amps
Above 100 Amps
TOT� D • � �
DISZ`B I�NECTED IF NOT COMPLETED WITHIKI 18 MONTHS.
OFFICE USE ONLY This request void 18 mo�ths from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Req�esf Date Rough-in inspection required? ❑ Yes � No Inspection Olfie� Than Rough-ln: � Ready Now � Will Call
3/ 30 / 00 You must call fhe inspecfor when ready Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: