P - 82445REQUEST FOR ELECTRICAL INSPECTION �
U!�5 6 3�� q J � Minnesota State Board of Electricity �
. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 i��:
` (651) 642-0800 www.electricity.state.mn.us `�$�
Home I � Duplex � � Apt.
Commercial Indusirial Farm Remod Repair
Air Condifioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" pbove ihe work covered by this request. Enter remarks in this s ace and.on the b ck of the�/w�hiie cop only.
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Calculote Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Ofher Installafions fee # Servic france Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall t 20 Amps „�� 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TDTAL
Sign / Outline Ltg. Xfmr. � � ,
Alarm/Remote Control
Swimming Pool �' �� QZr Oc�
I hereb certi that I ins ted the elechical insfallation dexribed herein on the 6ates sfafe�:
Irrigation Boo " ^ RougMn Dare
Special Inspection t �d�
Investigative Fee F��ol � _ � ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFlCE USE ONLY This requesf void 1 S mo�fhs from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? �Yes ❑ No Inspection 01her Than Rough-In: ❑ Ready Now�Will Call
�p �� p� You must coll the inspecfor when ready Date Ready:
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1, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: