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Industrial I I farm
REQUEST FOR ELEGTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite 5-12&.Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e%ctricity.state.mn.us���
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Other: New
I IDryer I IRange I IElec. Heat I ,Temp. Service I ,
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Ofher Installations Fee # Service Entrance Size Fee # Circuiis / 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
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
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� InvesFigative Fee � �
THIS INSTALLATION MAY BE ORDERED
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the electrical installation
Date
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DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from vafidation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes No Inspection Ofher Than RougMn: ❑ Ready Now Will Coll
��'�� You musf call the inspecfor when ready Date Ready:
1, licensed controctor ❑ company ❑ owner hereby request inspection of the above electrical work at: