P - 80781i
- 0-854-583 02
REQUEST FOR ELECTRICAL INSPECTION E
Minnesota State Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _ -
(651) 642-0800 www.e/ectricity.stafe.mn.us
Home Duplex Apt. B{dg. Other: New Addn
Commercial Industrial Farm Remotl Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request. Enter remarks in this space and on the back o► the whlte copy onry.
NSP SAVER'S SVVITCH Ih1S'fALLATI�V
Calcu/ate Inspection Fee - This Inspection Request wil/ not be accepted without the correct fee.
�ther Installations Fee # 3ervice Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
TransformerJGenerator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swrimming Pool
��. I herebvi certiN that I insoected the electrical
0 to 100 Amps
Above 100 Amps
TOTAL o Q,;
-�.�Q
�n described herein on the dates stated:
nvestigative Fee F�� (�1C�C� �-- I J" �''"�1 I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
���LL.�.��Wy.�.y��.�W W�.�.y.�.�.�.�.�y.�.� �OFFICE USE ONLY This request void 18 moMhs from validation date priMed in this box.
�IIIII �IIII I�I�I IIII� IIII� IIII� �II �II� (II� • V `� ' J�/
*08545$32* ���
I Request Date I Rough-In inspection required? ❑ Yes ❑ No I Inspection Other Than Rough-In: O Ready Now ❑�II Call I
You must call the inspector when ready� Date Ready: x
�� �
I, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: