P - 82087� REQUEST FOR ELECTRICAL INSPECTION " °4„
�-859-814 � Minnesota State Board of Electricity
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _
� (651) 642-0800 www.electricity.state.mn.us : °
x Home Duplex Apt. Bltlg. Other: New Adtln
Commercial Industrial Farm Remod Repair
Air Conditioner 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 the back of the white copy on/y.
NSR 3AVER'3 3WITCH
Ca/culate Inspection Fee - This Inspection Request will not be accepted without the correcf fee.
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certity that I inspected the �
Rough In
0 to 100 Amps
Above 100 Amps
TOTA' L,�$�
n described herein on the dates statE
Date
� � Investigative Fee � � � � ����—�'–L.�-
THIS 1NSTALLATION MAY BE ORDERED DIS ONNECTED IF NOT COMPLETED WITHIN 18 MON7HS. �
OFFICE USE ONLY This request void 18 months from validabon date printed in this box.
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*08598146*
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? O Yes ❑ Inspection Other Than Rough-In: eady Now ❑ Will Call
Q�%'�4%Q� You must call the inspector when reatly! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: