P - 80403._ .
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REQUEST FOR ELECTRICAL�INSPECTION � �
Minnesota State Board of Electricity' � ov:v ;
1821 University Avenue Suite S-128, Saint Paul�'. Minnesota 55104-2993 ���:
(651) 642-0800 www.electricity.st�te.mn.us '� '
Home Duplex Apt. Bldg. Other. New
i
Commercial Industrial Farm , emc
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:�'^
Dryer Range Elec. Heat Temp. Service � e�O i���-(O
"X" above the work covered by this request. Enter remarks in this space and on t e back of the white
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copy
Repair
Calculate Inspection Fee - This Inspection Request will not be accepMid I�+'�wi11Ae correct fee:
Other Installations Fee # Service Enhance Size Fee / C n.vik heders Fee
Mobile Home Park Stall 0 to 200 Amps f b tOQ Amps
Street Ltg. / Traffic Sig. Above 200 Amps ?Ibow 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY ' TOTAL
Sign / Out�ine Ltg. Xfmr.
� �/Or�
Alarm/Remote Control
Swimming Pool
I here certi thot I ins e electrical installdion liw�i� on the dates atated:
Irrigation Boom Rough-In �a�a �
Special Inspecti � �' 2 �
Final �� ... �� � ���1��
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMM-E7'EC WITHIN 18 MONTHS.
.. OFFICE USE ONLY This requesf wid 18 nwnlhs 6om validation date printed in this box.
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*08896318 � q�0
P�,EA�E �NT OR TYPE
Request Dale Rough-in inspecfion required� �Yes ❑ No Inspecfion Olha 7han RouQh-In: ❑ Ready Now Will Call
2— 2]. —� � You must call the inspector when ready Date Rwdy:
I,�licensed contractor ❑ company ❑ owner hereby request inspection oF Ih� aboMe electrical work at: