P - 82512U-8�5-567 �1
Home Duplex
ommercial Industrial
Air Conditioner Hfg. Equip.
Dryer Range
"X" above the work covered by
Calculate Inspe�
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Oufline Ltg. Xfmr.
Alarm/Remote Control
Swimmin� Pool
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
Apt. Bldg. Other: �� L �' � Ne�
Farm � n � _ ,� _ , //.{'%'�.. �/7� Ren
�c. Heat I I Temp. Service I
request. Enter remorks in this space and on
��i�
Repair
copy only.
Fee - This Inspection Requesi will not be accepted wiihout the correct fee:
# Service Entrance Size Fee # Circuits / Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTP�
p�or v `i
I herebvi certiH that I inscected the elechical insMllation described herein on the dates stated:
-- F,�a� ���� � �� 3�O �
Investigative Fee —
THIS INSTALLATION MAY BE ORDERED DIS ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S monfhs (rom validation dafe printed in fhis box.
:_ I�N��Illli����i�lll _ �s��° �
i N�III �� I�
* 0 8 8 5 5 6? 8* n� ��j��
1�' � PLEASE PRINT OR TYPE
Requesf Dale Rough-in inspecfion required? ❑ Yes o Inspecfion Other Than Rough-In: ❑ Ready Now 'll Call
��� . You must call fhe inspector when ready Date Ready:
I, �li�ensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: