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Home Duplex
Commercial Industri
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Dryer ange �
"X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity ;
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ?�� �
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amps ; 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL t�-''O
Sign/Outline Ltg. Xfmr. � ��
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ected fhe electrical insfallation described herein on fhe dates stated
Irrigation Boom Rough-In Date
Special Inspecti - ?J6 - �
Final p _ � 7 �
Investigative Fee �jz_ �
THIS INSTALLATION MAY BE ORDERED DISCO IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlC USE ONLY This request void 18 months from validation date printed in fhis box.
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EASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion r uired? Yes
e9 ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
l�^^ _ (You musf call the inspector when ready) Date Ready:
I, ' nsed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address �Sfreet, Bo or Roufa.Alo.)
Ciy Zip Code
Section No. ownship Name or No. Range No. Fire No. County
Occupbrlt
,�( � Phone No.
tlechfcal Conhocfor �Company
Mailing Address (Conhacior or
Conhactor License No. Master Lic. No. (Planf Elect.
or �nvne/rerrorm7ng Installafion) �� ^ t� � P
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STATE BOqRD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY