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
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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.
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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: