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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity �'
7821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us '� '
Other: New Addn
Commercial Indusfrial Farm Remod
Air Conditioner Htg. Equip. Wafer Hfr. Load Mgmt. Other:
Dryer Range Elec. Hea1 Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspecfion Request will no► be accepted without the correct fee:
Other Installations Fee # Service Enfrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Streef Ltg. / Traffic Sig. Above 200 Amps - Above 100 Amps
Transformer/Generafor INSPECTOR'S USE ONLY TOTAL
Outline Ltg. XEmr.
Remofe Co�trol
ing Pool
I
m Boom
Inspection
I ins ted the electrical installation described herein on the dates stared:
Date
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� Investigative Fee � � � ' �� � '_ ' � � �- �.`J$ — G� �
THIS INSTALLATION MAY BE ORDERED DISC TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months (rom validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required? ❑ Yes ❑ No Inspection Ofher Than Roughan:�eady Now ❑ Will Call
3" ��� � b You musf call fhe inspecfor when ready Dafe Ready:
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: