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Industrial
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
Apt. Bldg. Other: New
Farm Remc
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Repair
Air Conditioner Hig. Equip. Wafer Htr. Load Mgmt. Other: I
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the hite copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correci fee.
Other Installations Fee rvice Enfrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps j� � 0 to 100 Amps
STreet Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 30. 5�
Siqn / Outline Ltq. Xfmr.
Pool �
� I herebvi certifv that I insoected the elechical installation described
Date
Ins�e�� V m t� �
Investigative fee r����� � � � ��•-O�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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�uest Date Rough-in inspection required$ ❑ Yes No
9` 18—�� You must call fhe inspecfor when ready
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PLEASE PRINT OR TYPE
Inspection Other Than Rough-In: ❑ Ready Now Will Call
Dafe Ready: .
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: