P - 80784* REQUEST FOR ELECTRICAL INSPECTION
�tJ—V54-653 03 Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.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 only.
NS'P SAVER'S SWITCH iNaTALLATION
Calcu/ate Inspection Fee - This Inspection Request wi/l not be accepted without the correct fee.
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'S USE ONLY TOTAL ��'
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereby certi(y that I ins ed the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
i� Special Inspection
Investigative Fee �'� Dace � �,Z _Q
w���� THIS INSTALLATION,MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
,,Ywy. ����w� •w�•�•-••N .�^ .�•� OFFICE USE ONLY This request void 18 months from validation date prinied in tl�is box.
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*08546533* �7�/
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Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than Rough3n: � Ready Now ❑ Will Call '
���.��pp You must call the inspector when ready� Date Ready: t1 __ ___ �_
I, [�Qicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: