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Home Duplex
Commercial Industri
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RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612)642-0800
I Farm
ip. Water Hh. Load Mgmt. Other:
Elec. Heat Temp. Service
�y this request. Enter remarks in this space and on the back
New
copy
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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' � S Q
Sign/Outline Ltg. Xfmr. l
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ed the electrical insmllation described herein on the dates stated
Irrigation Boom �.. RougMn Dar�
Speciallnspectio ( '� C-r��f
Final - Dat
Investigative Fee � �~ /-Z� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validafion date printed in fhis box.
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* � 4 9 8 9 5�% �* PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required2 ❑ Yes ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now ❑ Will Call
q� �� �You must call the inspecfor when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Street, ox, or Rot�te No.) �j �.. City ` Zip Code
� $ � i�rl.� �'e�� h �G iL.1. � C..�
Secfion No. Township Name or No. Range No. Fire No. County
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OccuoeM Phone No.
Mailing Address
nv Off�
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n � � .� �,3�$� Contr<
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or Own Ilafion)
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icfor or Owner Performing Insiallafio � M�
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STATE BOAHD COPY - SEE INSTRUCTION!
Master Lic. No.
No.