P - 81078REQUEST FOR ELECTRICAL INSPECTION :��
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(651j 642-0800 www.electricity.state.mn.us '��
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
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 the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations fee # Service Entrance Size Fee # Circuih / Feeders Fce
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Troffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T
Sign / Outline Ltg. Xfmr. ro
Alarm/Remote Control
Speciallnspection � L�
Imestigplive Fee �� �� — `"'��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY 7his request void 18 months from validation date printed in this box,
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PtEASE PRtNT OR TYPE
Requesf Da% � Rou h-in ins ction r uired$ Yes
g pe eq ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now ill Call
�// � You must call ihe inspactor when ready Dafe Ready: ._
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: