P - 82280REQUEST FOR ELECTRICAL INSPECTION �
U��•(� 6� Z�� � Minnesota State Board of Electricity �'
�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 i�����
'� (651) 642-0800 www.electricity.state.mn.us '' '
ome Duplex Apt. Bldg. Ofher: New Addn
Commercial Inclusirial Farm Remod Repair
Air Condifioner Htg. Equip. Water Hir. 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 white copy only.
R����1���� F� r�n�e
Calculate Inspection Fee - This Inspection Requesf will noi be accepted wiihout the correct fee:
Other Installafions 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 U�E ONLY TOTAL
Sign / Outline Lig. Xfmr. ,� i��
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted fhe elecfrical installation described herein on the dates stated:
Irrigation Boo Rough-in Date
Special I�spec'fl�
Investigative Fee ����� 2 —�"''d`L_
THIS INSTALLATION MAY BE ORDERED ECTED IF NOT COMPLETED WI HIN 18 MONTHS. �
OFfICE USE ONLY This request void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins ection re uired8 ❑ Yes
g p q ❑ No Inspection Ofher Than Rough-In: � Ready Now � Will Call
��� ��o You musf call fhe inspecfor when ready Date Ready:
I,�licensed contractor ❑ company ❑ ow�er hereby request inspection of the above electrical work at: