P - 82073REQUEST FOR ELECTRICAL INSPECTION
�s59-8o0 � 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 Dupfex Apt. Bldg. Other: New Addn
Commercia� Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
x^ apove the work covered by this request Enter remarks in this space and on the back of the white copy on/y.
Calculate Inspectii
Dther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
I
NSP 3AVER'S SWITCH
Fee - This Inspection Reauest will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certilv that I
without the correct fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL
--��
Q �
n described herein on the dates stated:
Date
Special Inspection
Investigative Fee F��� �� .--1 ( —C
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITr.FII�1,�M�„I�,THS;,,�.r
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
I IIIIN II{I{ I{III INN IIIII IIN{lIY�IINI I{I{ I{II • a� .�
*08598005* a��3
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? O Yes ❑ Inspection Other Than Rough-In: eady Now ❑ wll Call
(��'���� You must call the inspector when readyl Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: