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Home I I Duplex I Apt.
Commercial Industrial Farm
REQUEST FOR ELECTRfCAL 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 '���
Other: New Addn
- Air Condifioner Hig. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enier remarks in this space and on the back of the white copy
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Calculaie Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL�
Sign / Outline Ltg. Xfmr. •
Alarm/Remote Control ��
Swimming Pool
I hereb certi that I ins ected the electrical insrollation described herein on the dates staied:
Irrigation Boom Ro�aF�ln Dare
� Investigative Fee ^° v .'. • v I � � ' _ I � ��� ' p�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF MOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18� monfhs from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
R8'QY%���,at= �^� Rough-in inspection required? ❑ Yes o Inspection Other,Tha=Rqugh-In: Ready Now ❑ Will Call
L� ��� U You must call the inspecror when ready Date Ready: �� V�—` �
I, �icertsed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: