P - 81057, � 0-855-714
❑ REQUEST FOR ELECTRICAL INSPECTION
2 Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us : • '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Eiect. Heat Temp. Service
'X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
NSP SAVER'S SW! TCH ! NSTALLA7] ON
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Calculate lnspection Fee - Thrs Inspectiort Request wiJl not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Am�
TOTAL
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I hereby certity that I ins ected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
S ciallnspection
Investigative Fee ina� `� , ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This uest vdd 18 months from validation date rinted in this box.
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*08557142*
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yesxq No Inspection Other Than Rough-In:�7 Ready Now ❑ Will Call
j��g You must call the inspecror when ready! Date Ready:
I, ❑ Ji�ensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: