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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
i821 University Avenue Suite S-128, Saint Paul, Minnesota 551044993 -
(651) 642-0800 www.electricity.state.mn.us :--� `
g Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod 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 ihe back of the white copy on/y.
Calculate Inspection Fee - This
nstallations Fee #
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outiine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
N3P SAVER'S SWITCH
not be accepted without the
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
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Irrigation Boom I hereby certity that I ins ected the electrical installation described herein on the dates stated:
Rough In Date
Speciallnsp r'
Investigative Fee ��� � �-ti _ �, Z
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI HIN 18 MONTHS.
................. . . . -- - -- - - - ...................»........._»...�.......,..,............,..».�....�..............
OFFICE USE ONLY This request void 18 months from validadon date printed in this box.
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*08598187* °��`�`3
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes � N� Inspection Other Than Rough-In: VFieady Now ❑�II Call
(�/ha/(j(S You must call the inspector when ready! Date Ready:
I, �C] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: