P - 81899�
���927-450 �
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 "�'
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air C�jdif ner Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
„X" above the work covered by this re uest. Enter remarks in this space
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on the back of the white copy only.
Calculate Inspecfion Fee - This Inspection Request will noi be accepted wiihout fhe correct fee:
Other Installafions fee # Service Enirance 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 T�
$iqn / Outline Ltq. Xfmr.
Swimming P ��'�` 7 �"�at
I hereby certify that 1 inspected the elechical
IrriAation Boom u..,,,,t,a�
Date
Imestigative Fee '�JJ
THIS INSTALLATION MAY BE ORDERED DISC D IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requast void 18 months kom validation dafe printed in this box.
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PLEASE PRINT OR TYPE
licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: