P - 82342.
1^t11 �_822 � REQUEST FOR ELECTRICAL INSPECTION
V Minnesota State Board of Electricity '�
1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.elecfricity.state.mn.us : '
Home Duplex Apt. Bldg. Other: New Addn
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 on/y.
NSP �AYER'3 SWITCM
Ca/cu/ate Insoection Fee - This lnsoection Reauest will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
# Service Entrance Size Fee # Cirouits / Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
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I hereb certify that I in ected the electrical installation described herein on the dates stated:
Rough In • Date
� � Investigative Fee � � ( `� ' - �lim '�� �'--��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
......................... . ............... . . ................,....... ........
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��I�I�I (I�I� IIII� �II�I �I�I� �� �1I� IIII (�I OFFlCE USE ONLY This requeat vad 16 months from validation date printed in this box.
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' PLEASE PRINT QR TYPE
Request Date Rough-In inspection required? ❑ Yes � N� Inspection Other Than Rough-In: � Ready Now ❑�II Call
�,,� � iyyY� You must call the inspector when readyl Date Ready:
I, [jdicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
E8-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY