P - 82069� � REQUEST FOR ELECTRICAL INSPECTION ��•
U-���- 0� 0 � Minnesota State Board of Electricity
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� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
' (651) 642-0800 www.electricity.state.mn.us '�ffi�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Wafer Hfr. Load Mgmt. Ofher:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this spac anc�ibl�the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Insfallations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps �
$treet Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL� SU
Sign / Outline Ltg. Xfmr. � �
Alarm/Remote Control
Swimming Pool ���� � �d
I hereb ceAi that I ins cted the electrical instal�ation described herein on the s s
Irri9ation Boom Rough-In Dare
Speciallnspection "��� r�7```�
� Final � � Dat _ �,y ,� �-� �
Investigative Fee � �CJ
THIS INSTALLATION MAY BE ORDERED DISCONNEC D IF NOT COMPLETED WITHIN 18 MONTHS.
OPFlCE USE ONLY This request void 1 S monfhs from validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now �,Will Call
�'" � 8� � � You must call the inspector when ready Date Ready:
1, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: