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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 ''°�'�
ome Duplex Apt. Bldg. Other: New Naan
Commercial Indusfrial Farm emod Repair
Air Condiiioner Hfg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. $ervice
"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 Request will not be accepted without the correct fee:
Other Insfallations Fee # Servic trance Si Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 200 Amps � 0 to 100 Amps
Street Lfg. / Traffic Sig. A ove 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL w� �
$ign / Outline Ltg. Xfmr. ! '��
Alarm/Remote Control
$wimming Pool
I hereb certi thai I ins ted the elechical installation described herein on the dates smted:
Irrigation o Ro„9MI„ Dare ` Z^ b�
Special I
Final
Investigative Fee ���— � � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
` OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requ i Da�te/ Rough-in inspection required8 Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now 0 Will Call
�(� // �Vv . You musf call the inspecfor when ready Date Ready:
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I,�'icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at;