P - 82128� REQUEST FOR ELECTRICAL INSPECTION �
U � � � � � � � � � Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 �����
� (651) 642-0800 www.electricity.state.mn.us '�•
Home Duplex Apt. Bldg. Other:� ��' New Addn
ommercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calcula►e Inspection Fee - This Inspection Request will not be accep►ed withoui the correci fee:
Other Insfallafions Fee # Servic Entrance Si F # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT
Sign / Oudine Ltg. Xfmr. `�
Alarm/Remote Control /'4�� � � f �
Swimming Pool p��� J�d
I hereb certi that I ins d the electric ' ation describ€d"Nere�on th a s .
Irrigation Bo Rough-l� e.� Z,,,,F� �
Speciallns ti + f _-
_ :. . .: � Final . D '� �� �. .
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNEC7ED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 18 monfhs from validation date printed in fhis box.
I�IINI�III�N�NINNIH�IHllilllllll � �`a��
* 0 8 8 5 5 0 0 9* �7�5
PLEASE PRINT OR TYPE
Request Date Rou h-in ins ection re vired$ es
g p q ❑ No Inspection Other Than RougMn: ❑ Ready Now ili Call
�" y � You must call the inspector when ready Dafe Ready:
l, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: