P - 81205REQUEST FOR ELECTRICAL INSPECTION -
� � � � � � � ry � Minnesota State Board of Electricity �
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J.. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-29
(651) 642-0800 www.electricity.state.mn.us '� '
ome Duplex Apt. Bldg. Ofher: New Addn
Commer 'al Industrial Farm Remod epair
Air Htg, Equip. Water Nir. Load Mgmt. Other:
Dryer ` Range Elec. Heaf Temp. Service
"X" above the work covered by this 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 no► be accepted without ihe correct fee:
Other Installations Fee # Service Enirance Size Fee # Circuifs / feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps GO
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T�TAL
Sign / Outline Lig. Xfmr. o O
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ted the electrical instaliation described herein on the dates stated:
Irrigation Boc�ry yy r- � RoupMn Date
I � Investigative Fee I I� � ��i°-- I"��� d��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH 18 MONTHS;,
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OFFICE USE ONLY This reqwst void 18 months from validafion date printed in this box.
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*oBaLLOLO� 75�5"
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required$ ❑ Yes o Inspection Other Than Rough-In: R ady Now 0 Will Call
"' 1'�' G q You must call the inspecfor when ready Date Ready:
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I,'�jcensed contractor ❑ company ❑ owner hereby request inspection of the above elecfrical work at: