P - 81185e
� REQUEST FOR ELECTRICAL INSPECTION
O'854-624 � Minnesota State Board ot Electricity -
y 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us : `
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y.
NSP SAVER'S SVIATCH !P)STALLAT101V
Ca/culate
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
Transformer/Generator
Sian f Outline Lta. Xfmr.
Boom
Fee -
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL���
� o�o- `:ra�:� .
�n described herein on the dates stated:
Investigative Fee F��� ��Gs--�----- I�- 22^-cu % I
THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITtIIN 18 MONTHS.
..,...�,.......... w .................................,. �....., �......... �.a..u.N..-�....,....W..,....................�__.�._...,..M
OFFICE USE WiLY This nequest vdd 18 morAhs from validation date printed in this box.
I liil�� I�iN I�II� �Ilfl i���1 �IiIIryl`IINI ilil I�I� � 7��
*08546244*
P�r��If�M��
Request Date Rough-In inspection required? ❑ Yes Q AIp Inspectlon Other Than Rougl�ln: � Ready Now ❑�II Call
�1� You must call the inspector when readyt' Date Ready:
I, [a0icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: