P - 82438REQUEST FOR ELECTRICAL INSPECTION �
5 1 J-- 3 3 5 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �;
� Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the bock f the white cppy �nly.
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Calculaie Inspection Fee - This Inspecfion
Other Fee #
Mobile Home Park Stall
will not be accepted wirhout the correct fee:
e Entran Size Fee # Circuits/Feeders Fee
� Amp . Qa to 100 Amps . OD
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�v TOTAL
Sign/Oudine ltg. Xfmr. V�pd QT �• ��
�vy /
Alarm/Remote Conhol
Swimming Pool
_ 1 herebvi ceAifv tfwl I insoecled the elechirnl inslalk�tion drscri6ed herein nn �he da�es sreaerl
. � �y..��v�. ., RougM� Dale
Special Inspec ion � -
Final ��
Investigative Fee
THI5 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFF7CE USE ONLT ihis requesf vad 18 monlhs lidation dale�r' in this box.
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��°� , w Rough-in inspection required2 ❑ Yes No Inspecfion O�er Than RougMn: eady Now ❑ Will Call
� °� Y d ou must call the inspecror when ready) Date Ready:
licensed contractor ❑ owner hereby request inspection of the above electrical work at:
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Lic. No. (P4
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STA7E BOARD COPY - SEE INSTRUCTIONS ON BACK � YELLOW COPY