P - 82082, �-859-809 �6
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REQUEST FOR ELECTRICAL INSPECTION
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 ': - `
X Home Duplex Apt. Bldg. Other: New Addn
Commercial Intlustrial Farm Remod Repair
Air Contlitioner 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 tne vacK or tne wrnte copy onry.
Calculate lnspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Atarm/Remote Contro!
Swimmina Pool
N3P SAVER'3 3WI'TCH
Fee - This Inspection Request will not be accepted without the correct fee.
�e # Service Entrance Size Fee # Circuits / Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTA �$�
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I hereby certity that I inspected the electrical installation described herein on the dates Sfatf
Rough In Date
Investigative Fee F�� � �(�Z,�----�- I Uald �� -� �
THIS INSTALLATION MAY BE ORDERED DIS NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
,- ,. ..��Y����.�.�W �,�jY��,��ww�wW �»�:OFPICE USE ONLY This request void 18 rtwnths from validation date printed in this box.
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*'08598096* ���
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required7 � Yes � fr0 Inspection Other Than Rough-In: LJ�teady Now � Wdl Call
���,4�� You must call the inspector when ready! Date Ready: �
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: