P - 82257C�'.��52�385 0
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity 3
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ����i
(651) 642-0800 www.electricity.state.mn.us `���
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm
Air Conditioner Htg. Equip. Water Htr, load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" pbove Ihe work covered by this request. Fnter remarks in thrs space and on
REPAIR MAST — STORM DAMAGE
copy
Repair I
Calculate lnspection fee - rhis lnspeciion Requesi wil! noi be accepted without the correcr fee:
Other Installafions Fee # Service Entronce Size Fee # Circuits / Feeders Fee
Mobile Home Park Stal) 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
Sipn / Outline Ltq. Xfmr. . 20. 50
I insoected ihe elechical installation described herein on the dates stated:
I I Investigative Fee I �� �� �^GV I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This requesf void 18 months from validation date printed in fhis ox.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins ection r uired?
g p eq ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
�7� 13�00 You musf call }he inspector when ready Dafe Ready:
I, � licensed contractor ❑ comppny ❑ owner hereby request inspection of the above electrical work at: