P - 825520-95a=484 �
Dryer
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Swie S 128 Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
Duplex Apt. Bldg. Other:
ial Industrial Farm
itioner Htg. Equip. Water Htr. load Mgmt. Other:
Range Elec. Heat Temp. Service
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the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
Other Installafions Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control o�� �
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dafes stated:
Irrigation Boom Rough-In �a�e `
Special Inspection
Final Date ��.�% .
Investigative Fee O �
THIS INSTALLATION MAY BE ORDERED DISCO ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes �No Inspecfion Other Than Rough-In: ❑ Ready Now�Will Call
�°ao "��O You must call the inspector when ready Dote Ready:
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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5EE INSTHUCTIONS ON BACK OF YELLOW COPY