P - 82599REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � � Minnesota State Board of Electricity � 3_
, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ���
(651) 642-0800 www.electricity.state.mn.us �+��:=�`
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Repair
Air C�i er Hig. Equip. Water Hir. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reques�. Enter remarks in this space and on e back of the white copy only.
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Calculafe Inspeciion Fee - This Inspection Request will not be accepted wiihout 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
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL/)� �
Sign / Outline Lig. Xfmr. ����
Alarm/Remote Control
Swimming Pool
Irrigation Bo
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I Investigative Fee I� I����V�
THIS INSTALLATION MAY BE ORDERED
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that I ins ected the electrical installation described herein on the dates stated:
Date
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)ISC ED IF NOT COMPLETED WITHIN 18 ONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion date prin}ed in this box
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PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes � Inspection Other Than Rou h-In: ead Now
You musf call the inspector when ready Dafe Read 9 Y � W�II Call
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contractor ❑ comppny ❑ owner {,o.oL,., .,.,.,..._. .___ _ . , ., .
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