P - 82335` ' REQUEST FOR ELECTRICAL INSPECTION
r� � g� 6� 4� Z � Minnesota State Board of Electricity
LJ 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
,! (651) 642-0800 www.electricity.state.mn.us "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfriol Farm Remod Repair
Air Conditioner Hfg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above 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 accepted without the correci fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps (r
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Trans4ormerjGenerator INSPECTOR'S USE ONLY TOTAL '�
Sign / Outline Ltg. Xfmr. NQ
Alarm/Remote Control p�Q
Swimming Pool I hereb certi that I ins fed fhe electrical installafion described herein on Ihe dates sMted:
Irrisaation Boom e„��„h_i„ oare
Investigative fee �n�� � ��—���� � V�� �Z'O`GJ
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfiis from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Request Date � Rough-in inspection required8 ❑ Yes � No Inspection Other Than RoughJn: �2eady Now � Will Call
/� y��(� You musl calV ihe inspector when ready Date Ready: f�/�Q 0
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I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: