P - 82465REQUEST FOR ELECTRICAL INSPECTION -
� � � � � � � � � � Minnesota State Board of Electricity 3
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ���.
" (651) 642-0800 www.electricity.state.mn.us " '
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Hta. Eauio. Water Htr. Load Mamt. Other:
I I Dryer I I Range I I Elec. Heat I I Temp. Service I
"X" above ihe work covered by this reqvest. Enier remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Reques► will no► be accepfed wiihout the correci fee:
Other Insfallafions Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Lfg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAI,� �
Sign / Outline Lt . Xfmr. �(,�"- %?�'S'°t L
Alarm/Remote Control
3 Pool
Boom
Special Inspection — � "
Final
Investigalive Fee
THIS INSTALLATION MAY BE ORDERED
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* 0 8 8 6 3 0 6 �*
that I inscected the elechical insfaltafion described
Dote
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IF NOT COMPLETED WITHIN 1S MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date . � Rough-in inspecfion required2 ❑ Yes Inspecfion Ofher Than Rough-In: �teady Now ❑ Will Call
You�musf call fhe inspector when ready Dafe Ready: -�.
1, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
C°-"""" "' "�"" STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY