P - 82157REQUEST FOR ELECTRICAL IN�PECTI�N ���
U � � � � � � � � � Minnesota State Board of Electricity �'
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
1 r (651) 642-0800 www.electricity.state.mn.us '_�'�
Duplex � �Apt.
Commercial Industrial Farm
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reques�. Enter remarks in this space and on fhe back of
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Calculate
Mobile Home Park Stall
$treet Ltg. / Traffic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
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Fee - This Inspection Request will not be accepted without the correct fee:
# Service Entrance Siz Fee # Circuiis / Feeders Fee
f 0 to 00 Amps �p,o0 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
,30, .$�lJ
I herebvi certifv that I insoected the electrical insfallation described herein on fhe dates stafed:
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Investigative fee
THIS INSTALLATION MAY BE OR RED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required$ ❑ Yes No Inspection Other Than Rough-In: eady Now � Will Call
�j ��g -0d You must call the inspecror when ready Date Ready: s�� ptj
I, icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: