P - 82075� REQUEST FOR ELECTRICAL INSPECTION �" E
, V-859-802 1� Minnesota State Board of Electricity F:-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us �'� -°`
Home Duplex Apt. Bltlg. Other: New Atldn
Commerciai industrial Farm Remod Repair
Air Contlitioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
x° aaove tne work coveretl by thls request Enter remarks in this space and on the back ot tne wnite copy only.
N3P SAVER'3 SWITCH
Ca/cu/ate Inspection Fee - This Inspection Request will not be accepted without the conect fee.
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
TransformedGenerator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereby certity that I inspected the �
Irri ation Boom
0 to 100 Amps
Above 100 Amps
TOTAL
.i$�cr
aas
n described herein on the dates state
9 Rough In Date
Special Inspe � r/�
Investigative e � Final �a � Z� _�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
���� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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�`08598021 * oZ�l3
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? 0 Yes ❑� Inspection Other Than Rough-In: �leady Now � Will Call
��h w� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection o# the above electrical work at: