P - 82541REQUEST FOR ELECTRICAL INSPECTION �����
7 r%7 Minnesota State Board of Electricity � 3�
��'�..� � 1�� L 1 � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "�`�
plex Apt. Bldg.
lusfrial Farm
Repair
Air Co i er Htg. Equip. Water Htr. Load Mgmt. Uther:
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 Inspecfion Request will not be accepted without the correct fee:
Other Installations Fee # Service Enirance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. t.liG r""' �°� �
Alarm/Remote Control
Swimming Pool I hereb certi that I ins ected the electrical insfallation described herein on the dates stated:
Irriaation Boom Rouqh-In oore
Special Inspection Final
Investiqative Fee
THIS INSTALLATION MAY BE ORDERED
IIII II I�I rl I�I I� rll II III II �II �I III ll III I l�l
* 0 9 6 7 0 2 7 4�
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DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS. _
OFFICE USE ONLY This requestyfyld 18 months from validation date printed in fhis box.
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� P EASE PRINT OR TYPE
Dafe Rough-in inspecfion required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: �Ready Now 0 Will Call
�- I��-��� You musf call ihe inspecfor when ready Dafe Ready:
1, ��.licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: