P - 82181U-�18-567 �
Duplex
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1827 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 ±�;
(651) 642-0800 www.electricity.state.mn.us 'm�'
Apt. Bidg. Other: New Addn
Farm Remod Repair
Air Conditi Htg. Equip. Wafer Htr. Load Mgmf. 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.
Calculate Inspec►ion Fee - This Inspection Request will no► be
Other Installations fee # Service Enhance Size Fee
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted the elechical i
Irriaation Boom � _ _ _ a���.,ti_i.,
' — Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED
_, ----- -�-- -- —
I�NU�IIIII�IIIH���I���l�l
* 0 9 1 8 5 6 7 9*
epted wi►hovt the correc� fee:
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
herein on the dafes stafed:
/ �c� Il�=- '3 '�`—
DISC ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFflCE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
RequesT Dafe Rough-in inspecfion required$ ❑ Yes �No Inspecfion Ofher Than Rough-In: �}�ady Now ❑ Will Call
5-2[�—OQ You must call the inspecror when ready Date Ready: ��
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: