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P - 82589REQUEST FOR ELECTRICAL INSPECTION �� � � � � � � � � S � Minnesota State Board of Electricity � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 (651) 642-0800 www.electricity.state.mn.us ':��a:- Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Air ioner 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 or �� ���L ��� � ��C,�r�n�, �- � �ji�4�c� � �� Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee: Other Installations Fee # Service Enfrance Size fee # Circuits / Feeders 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. Alarm/Remote Control Swimming Pool Irrigation Boom Special Inspection I hereb cerfi that I ins ected the electrical installation described herein on the dates sfated: Rough-In Date Vare _ Investigative Fee - 2—Z —G` THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This requesf void 18 monfhs from validation date prin}ed in fhis box. I IIII II III I� I�) II III II III II II�I �II II : a�� r ,.e . III I IIII .�— * 0 9 7 1 9 2 8 7��U� � �� -� `-� � a ��1:� PLEASE PRINT OR TYPE Req esf Dote Rough-in inspecfion required? ❑ Yes ❑ No Inspecfion Ofher Than Rough-In: Ready Now ❑ Will Call �°��—O�� You must call the inspector when ready Date Ready: I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: