P - 80793> REQUEST FOR ELECTRICAL INSPECTION
�—V5"t-646 []7 Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
� (651) 642-0800 www.electricity.state.mn.us . `
Home Duplex Apt. Bltlg. Other: New Addn
Commercial Industrial Farm Remotl 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.
N5P SRVER'S �WITCH IfV�fALLATIC�V
Calculate Inspection Fee - This Inspection Request will not be
nstallations Fee # Service Entrance Size Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outiine Ltg. Xfmr.
Alarm/Remote Control
Boom
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebv certifv that I inscected the i
�ted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL ,
the
Investigative Fee _ r� �� ���� _ ��� •�'h' o d I
THIS INSTALLATION MAY BE ORDERED ECTED !F NOT COMPLETED WITHIN 18 MONTHS.
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' OFFICE USE ONLY This request vad 18 months irom validation date printed in this box.
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Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than RougMln: � Ready Now ❑�I� Call
�,�.)�� You must call the inspector when read� Date Ready: A ,�„�..r,,,�,,,
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: