P - 81475?�7-�34
Home Duplex
Commercial Industrial
Air Cond. Htg. Equi
Dryer ange
"X" above the work covered b
RE�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
Phone(612)642-OS00
Apt. Bldg. Other: New Addn
farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepted wilhoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fe
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 �antrel
Swimming Pool
I hereb certi that I ins cted the elechical installation described herein on fhe dates stated
Irrigation Boom Rough-In Date
Speciallnspectio i
t � Final
Investigative fee —�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
R t Date Rough-in inspecfion required2 ❑ Yes o Inspecfion Other Than Rough-In: Ready Now
❑ Will Call
- /��� �You musf call the inspector when ready� - Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route � City Z' Code
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ontractor License No. Masfe��
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