P - 80208REQUEST FOR ELECTRICAL INSPECTION � �
o���g 9 i 7 g g� Minnesota State Board of Electriciry
1821 University Avenue Sui�e 5428, Saint Paul, Minnesota 55104-2993 ��
• (651) 6a2-0800 www.electricity_state.mn.us ���,�
Dryer f I Range I I Elec. Heaf I I Temp. Senice I
"X" obove the work covered by lhis request Enter remarks in fhis spoce and on ihe back oF the white copy onl
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Calculafe Inspection Fee - 7his Inspedion Reques� will not be accepted wifhoui fhe mrred fee:
O'her Instullations Fee # Service En�mn<e Size fee # Circoifs / Feeders Fee
Mobile Home Pork Stall 0 fo 200 Amps —�� 0 to 100 Amps
Tronsformer/Generafor � � INSPECTOR'S USE ONLY �TOTAL
n / Oufline Lfg. X{mr.
rm/Remole CoMrol
mming Pool j
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jafion Boom
insmllanon
Special Inspecfion ���° � �-�1— 6^^'I
Investigative Fee F��al oo�/ 'L— Gz—
THIS INSTALLATION MAY BE OR�ERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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IY OFFICE USE ONLY This requesl void 1 B months from valida�ion do�e primed in this box.
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PLEASE PRINT OR TVPE
Reqoesl b Rough In inspetlion requlred? �i(es ❑ No Inspection OMer Than Rough�ln� ❑ Ready Naw.�'Will Call
f/ s�% aJ vo� m��r �ou �ha ���,�ra, whe� ,eoa� �oia eeadY,
I� Q.Iicensed coniroctor ❑ company ❑ owner hereby requesf inspecfion of fhe above elecfrical work al: