P - 80362.
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REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity �'
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �����
(651) 642-0800 www.electricity.state.mn.us `� •
Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Hfg. Equip. Wafer Htr. Load Mgmf. Ofher:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted wiihout the correci fee:
Ofher Insiallations Fee #$ervice Entrance Size Fee # Circuits / Feeders Fee
Mobi{e Home Park Stail 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL „
Sign / Outline Lfg. Xfmr.
Alarm/Remote Conhol
2'785�
that 1 ins ted 1he elechical installation d
5.5='
Irri9ation Boom RougMn Dare
Special Inspection ,
Final � . Daf
Investigative Fee '�"C5t"�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WiTHIN 18 MONTHS.
� OFFICE USE ONLY This requestvoid 18 months 6om validation date prinfed.in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection requiredZ ❑ Yes ❑ No Inspection Other Than Rough-In: � (Feady Now � Wifl Call
�� `I_ � O D You musf call the inspecror when ready Dafe Ready:
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I,� licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: