P - 82185REQUEST FOR ELECTRICAL INSPECTION �
U� g� 6 r� O� � Minnesota State Board of Electricity .o� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
- (651) 642-0800 www.electricity.state.mn.us ��
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod air
ir Conditi n Hfg. 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 white copy only.
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Calculate Inspection Fee - This Inspection Requesi will not be accepted without the correct fee:
Other Installations Fce # Service Enfrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps , 0 to 100 Amps
Street Ltg. / Traffic Si . Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 50
Sign / Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins cted the electrical installation described herein on ihe dates stated:
Irrigation Boo j r% , Rouah-In Date
I I Investigative Fee I I� (� ��/ I'IL -.).,., dt-� I
THIS INSTALLATION MAY BE ORDERED DISCO ED IF NOT COMPLETED WITHIN 18 MONTHS.
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�OFFlCE USE ONLY This request void 18 monfhs from volidation date printed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now � Will Cail
You must call the inspector when ready Date Ready:
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: