P - 82577REQUEST FOR ELECTRICAL INSPECTION �HE
�-� 14-824 � Minnesota State Board of Electricity ������
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 .`���;. ��
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(651) 642-0800 www.electricity.state.mn.us ���,��.
v Home Duplex Apt. Bldg. Other: New Atldn
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 only.
NSP �AVER'S SWITCH � �; � � "!
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct 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. ZQ,�jfl
Alarm/Remote Control
Swimming Pool
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
Investigative Fee Final o� Daie-, _ 22 -a l
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I IIIIIIIIIII IIIII IIIII IIIII II IIIII IIII IIII b��ICE�USE GIVLY�This request void 78 months from validation date printed in this box. ..4.�
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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
,� �� .�,� ,�� You must call the inspector when ready! Date Ready:
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�. �. ����^� �� ��� � stt w51 HUGTIONS ON BACK OF YELLOW COPY