P - 80383(:)�-917-554 �
Com merc ial I nd ustrial
Air Conditioner tg. Equ
Dryer Range
"X" above the work cove
Calculate Inspec
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Tra nsformer/Generator
Sign f Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
IrriQation Soom
Apt
REQUEST FOR ELECTRICAL INSPECTION °���
Minnesota State Soard of Electricity 3
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104-2993 =
(651) 642-0800 www.electricity.state.mn.us '��
Repair
I` I Elec. Heat I I Temp. Service I I
ry this request. Enter remarks in this space and on the back of the white copy only.
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��?77-- 7��.�
Fee - This Inspection Request will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits / Feeders Fee
0 to 200 Amps Q to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL �
fhe elechica) insfallafion described herein on fhe dafes stafed:
9 Final � '�L`_ _ . I Da1�-� �
Investi ative Fee � �� —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months hom validation date printed in this box.
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* 0 9 1 7 5 S 4� y l°� �a
PLEASE PRINT OR TYPE
Requesf Dafe Q Rough-in inspecfion required$ ❑ Yes �o Inspecfion Ofher Than. Rough-In: ❑ Ready Now �Vill Call
3^ (— �� You musf cpll fhe inspector when ready Date Ready:
1, �censed contractor ❑ company ❑ owner hereby request inspection of the above elechical work at: