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P - 80362. •�-�99-449 � Home 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. �O W er' .Su p� l y-14� r- Ca.�.b l,e. 7'. V. L' �. (,l f� I � �es ne � � �, C'o � � e.e�e�/ 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. l�illl Ililllilll � �� • , -�G Ili �� �I� l� � ��. * 0 8 9 9 4 4 9 3* �� ,�, (� � J� e� 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: a�-Y/ I,� licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: