P - 81186�, Q-854-611
REQUEST FOR ELECTRICAL INSPECTION
� Minnesota State Board of Electricity _
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us : '
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod 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 ot tne wn�te copy onry.
n� so�v�s swircH in�si'a�t.u��nav
Calcu/ate Inspection Fee - This
�ther Installations Fee #
will not be accepted without the correct fee.
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transtormer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
I herebvi certiN that I insoected the
0 to 100 Amps
Above 100 Amps
TOTAL �
o� ma detas s�ted:
)( Special Inspection �w� "
Investigative Fee F�� • �L.2z`-�'z._
THIS INSTALLA710N MAY BE ORDERED DISCONNECT'ED IF NOT COMPLE7ED WITHIN 18 MONTHS.
_,_.�..,._..__..._..,�....._ _._....,...__.____._, _��w..,-_�_._ ...�......�CE USE ONLY This request vad 18 momhs from validation date printed in this box.
I IIIIII ��I�I III�I IIIII �I�I� ��I�III� II�I I��I � 7��0�
*08546111* __
Request Date
Rough-In inspection required? 0 Yes ❑ Inspection Other Than Rough�n: � Ready Now � Will Call
� f�7� You must call the inspector when ready� Date Ready: �� ��„� „�
I, [a4icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: