P - 82271.(.�-��37-454 �
Home Duplex
Commercial Industrial
Air Conclitioner Htg. Equip.
Dryer Range
"X" above the work covere
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.electricity.state.mn.us "�'
Apt. Bldg. Other: New Addn
Farm Remod Repair
ater Htr. Load Mgmt. Other:
�c. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Caicuiate Inspection fee - This Inspection Request wiii not be accepted without the correct fee:
Other Installations Fee # Service Enfrance Size Fee # Circuifs / 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 USE ONLY
Sign / Outline Lt . Xfmr. G�u,...� �
Alarm/Remote Control
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I hereb certi �at I ins ected the electrical installation described herein on the dates stofed:
Irrigation Boom Rough-In �a � 2p ��
Special Inspectio pa�
Finol � �i'� „ � C%
Investigative Fee O
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. '
' OFFICE USE ONIV This requesf void 18 monihs from validafion date prinfed in this box.
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contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY