P - 82578/� REQUEST FOR ELECTRICAL INSPECTION �s='� ..
1=(J 14-825 L Minnesota State Board of Electricity �
, 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 '�. ---
(651) 642-0800 www.electricity.state.mn.us `�:;��:`
„ Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remotl Repair
Air Contlitioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'x" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate lnspecti�
Other I�stallations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outiine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
N�P �AVER'� SWITCH
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Fee - This lnspection Request will not be accepted without the correct fee.
't Service Entrance Size
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
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I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
Final D�
Investigative Fee Z _ rr�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. �� .� � OFF�CE USE ONLY� This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ Nt� Inspection Other Than Rough-In: C� Ready Now � Will Call
,� �np .�.; .�� You must call the inspector when ready! Date Feady:
I, [�,iicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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