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REQUEST FOR ELECTRICAL WSPECTION
Minnesota State Board of Electricity ��
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =
(651) 642-0800 www.electricity.state.mn.us `�.�
Duplex Apt. Bldg. Other: New Adc
lndustrial Farm Remod F
Htg. Equip. Water Htr. Load Mgmt. Other:
Range Elec. Heat Temp. Service
work covered by this request. Enier remarks in this space and on ihe back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Installations fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps o 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY C� T
Sign / Outline Ltg. Xfmr. /L-+C SC- ��
Alarm/Remote Control yQ, �
Swimming Pool
I hereb ceAi fhat I ins ected fhe elec}rical insfallation described herein on fhe dates stoted:
Irri9ation Boom Rough-In • . Dare
Special lnspecti _
Investigative Fee F10°� Dare�± �/ ��
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THIS 1NSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monihs from validation date printed in this box.
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PLEASE PRINT OR TYPE
�est D '/, h R„\ Rough-in inspecfion required2 es ❑ No Inspection Other Than Rough-In: ❑ Ready Now�YJill Call
VVv% You must call ihe inspector when ready Dafe Ready:
1, icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: