P - 80396REQUEST FOR ELECTRICAL INSPECTION ��
r� � 9 0(] -�� ry � Minnesota State Board of Electricity ;
4 a �. 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
��� (651) 642-0800 www.electricity.state.mn.us '��'
Home Duple Apt. Bldg. Other:
Commercial strial Farm
Air Conditioner 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
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copy
Calculate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee:
Other Insiallations Fee # Service Enirance Size fee # Circuits / Feeders
Mobile Home Park Stall O 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.
Alarm/Remote Control 3 Q,
Swimming Pool
. I hereb certi that I ins fed the elecfrical installafion described herein on the dafes sfate�
k��Si�7r10I1 BOORi .. �euoh.ln � � Date
Repair
� � Investigative fee !"=�- �/ �__ �j�•`--�-�. - I o�'��5r-��
THIS INSTALLATION MAY 8E ORD�RED- if-NO� CAMP�€TED Ml[CHI�I 1Q_�THS.
����� OFRCE USE ONLY This request void 18 months from wlidation date printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe �� Rough-in inspecfion required6 ❑ Yes o Inspection Other Than Rough-In: eady Now ill Call
2�����D You must call fhe inspecfor when ready Date Ready:
I,�censed contractor ❑ company ❑ owner hereby request inspection of the above elechical work at:
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