P - 81072` REQUEST FOR ELECTRICAL INSPECTION
�'C75C�-344 � Minnesota State Board of Electricity
' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us � . • 'J
Home Duplex Apt. Bidg. Other: New Adtln
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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 only.
N3P 3AVER'3 SWlTGH
Calculate Inspecti�
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
- This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certi(y that I i�spected the electrical
Rough In
Special Inspection
Fi
Investigative Fee
THIS INSTALLATION MAY BE
I IIIIN Iflll Ilill IIIII illll IINI IlII�IMII IlII IIII
*08583445*
�ted without the correct fee.
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
T�Sb
� � � Da� ���d� d � �
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ED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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dFFICE USE ONLY This request vdd 18 monCis from validation date priMed in this boz.
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PLEASE PRINT OR TY
Re���t Rough-In inspection required? 0 Yes 0 No Inspeclion Other Than Rough-In: O Ready Now � Will Call
You must cail [he inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: