P - 82327U��8�-723
REQUEST FOR ELECTRICAL INSPECTION
� Minnesota State Board of Electricity
1821 University Avenue Suite 5-728, Saint Paul, Minnesota 55104-2993 �;
(651) 642-0800 www.electricity.state.mn.us '� �
Home Duplex Apt. Bldg. Other: New Adc
Commercial Industrial Farm Remod ep
Air Conditioner Htg. 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 ihe white copy only.
/YIOV�� �e.'vtcz
Calculaie7nspection Fee - This Inspection Requesi will not be accepted without the correct fee:
Other Installations Fee # Service�hance Size�, Fee # Circuits / Feeders Fee
Mobile Home Park Stall
Street Ltg. / Troffic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irripation Boom
I 0 0 20fj ps ' � 0 to 100 Amps
Above 00 Amps .{j� Above 100
INSPECTOR'S USE ONLY TC
that I ins ted the electrical installation described herein on the dates sfafed:
Dafe
invesngatrve reev V � J — U
THIS INSTALLATION MAY BE ORDER�D DIS CTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This requesf void 18 monfhs from validation date printed in fhis box.
li�ii�iiiiiii�iii�i��u���ii�i . 3�.�
* 0 9 8 6 7 2 3 5* ���
PLEASE PRINT OR TYPE•
Requesf Dafa Rough-in inspecfion required? ❑ Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now ill Call
!—a 's ��� You must call the ins for when ready Date Ready:
l, ❑ licensed contractor ❑ company owner hereby request inspection of the above electrical work at: