P - 80326.�-89�-563 �
Apt.
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity �' i
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us '� �
C.ommercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. 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 ihe white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Insfallafions Fee # Service Enfrance Size Fee # Circuits / 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 TOTAL 5'ci
Sign / Outline Ltg. Xfmr. � � ��—
Alarm/Remote CoMrol
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dates stafed:
Irrigation Boom,:,� r; �__ RouAMn Dare
IInvestigative Fee ����� - I u�i`�-6 �C.� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validation dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Roughdn: Ready Now ❑ Will Call
�.- '� '7 � Q� You must call the inspector when ready Date Ready:
I, licensed contractor ❑ company ❑ ow�er hereby request inspection of the above electrical work at:
Job Address (S}reef, Box, o�ute,N�.) � . City ` Zip Code
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Secfion o. Township Name or No. Range No. Fire No. Co
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pany w Owner Performi�
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Company or Owner Perfori
STATE 80ARD COPY
Phone No.
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Confractor License No. Masfer Lic. No. (Plant Elect. Only)
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3 Ins allafion) Phone Number
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY