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Commercial Industrial
Air Cond. Htg. Equi
Dryer Range
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RE(IUEST FOR ELECTRICAL INSPECTION —
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
reques►. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspeciion Request will no► be accepted without Fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall to 200 Amps � 0 to 100 Amps
$ireet Ltg./Traffic Sig. Above 200 Am s " Above 100 Ai
Transformer/Generator INSPECTOR'S USE ONLY TOT,
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I inspecfed the electrical installation dexribed herein on the dah
Irriaation Boom D...._L i_ -%�^� .. .
Fee
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THIS INSTALLIi110A MAif�CORDERED DISCONNECTED IF NOT COMPLETED WtTHIN 18 MONTHS.
OFRCE USE ONLY This request void 18 months from valida�ion date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rougl�in inspection required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�- � q �You must call the inspector when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.� Ciy Zip Code
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SeMion No. Township Name or . Range No. Fire No. C ntv �
Occupant
Po�Supplier
(ConhacfOr or
Name�
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Phone No.
onfracfor License No.
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Lic. No. (Planf Elect.
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