P - 81199REQUEST FOR ELECTRICAL INSPECTION
, 0-854-610 [�3 Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _ _
(651) 642-0800 www.e/ectricity.sfate.mn.us : �"�
Home Duplex Apt. Bldg. Other: New Addn
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.
P1SP SAVER'� SWITGH IN5TALW71pN
Calcu/ate Inspectii
0ther Installations
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Boom
Fee - This Inspection Request will not be accepted without the correct fee.
�e # Service Entrance Size Fee # Circuics / Feeders
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL ,
a
I hereb cerfi that I inspected the electrical installation described herein on the dat
' Rouah In Dete
Investigative Fee F'"a� � O�_ I oeca� �, `a / I
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THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY TMS request vad 18 months from validation date printed in ihis box.
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Request Date Rough-In inspection required? ❑ Yes ❑ 1� Inspection Other Than RougMn: ❑ Ready Now O wll Catl
�1 � You must call the inspector when ready? � Date Ready: ��
I, [aQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical wo�k at: