P - 82276REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � � Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
` (651) 642-0800 www.electricity.stafe.mn.us
ome Duplex Apt. Bldg. Other: New Addn
mmercial Industrial Farm Remod pair
Air Condifioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
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a culate Inspe� Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 00 Amps to 100 Amps
Street Ltg. / Traffic Sig. Abo e 200 Amps Above 100 Am s
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimminca Pool
� � Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED
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Requ afe ��� Rough-in inspection req
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herein on the dates stated:
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IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months From validation dafe printed in this box.
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