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RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
above the work covered by this request. Enter remarks in this space and on
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copy only.
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Calculate Inspection Fee - This Inspection Requesf will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders F
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 TOT;� (�p
Sign/Outline Ltg. Xfmr. nl�!' ��� +
Alarm/Remote Conirol
Swimming Pool
I hereb certi fhaf I ins ted the elecirical installation described herein on the dafes sfated
Irrigation Boom Rough-In Date
Special Inspecti
Ptrral ^ �� ��, .--c� C�
Investigative F
THIS INSTALLATION MAY BE ORDERED DISCO ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validafion dafe printed in this box.
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Request Date Rough-in inspection required? ❑ Yes No Inspection Ofher Than Rough-In: eady Now ❑ Will Call
� (You musf call the inspecfor when ready) Date Ready: �t Z
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sfreet, Box, or Roufe No.) Ciy � Zip Code
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Secfion No. Township Name or No. Range No. Fire No. Co
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Power Suoolie�
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Phone No.
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Conhactor License No. I Master Lic. No.
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'Y - SEE INSTRUCTIONS ON BACK OF YELLOW COPY