P - 82216U-��6-900
REQUEST FOR ELECTRICAL INSPECTION ��
� Minnesota State Board of Electricity �'
1821 Unive ' enue Suite S-128, Saint Paul, Minnesola 55104-2993 i���:
(651) 64 00 www.electricity.state.mn.us �_��
Apt. Bldg. Other: New Addn
Air ' er Htg. Equip. Water Htr. Load Mgmt. Ofher:
Dryer � Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in his space and on the back of the white copy only.
Calculate Inspeciion Fee - This Inspection Request will not be accepted without the correci fee:
Ofher Insfallafions Fee # Service Enfrance Size Fee # Circuifs / Feeders Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
$wimmina Pool
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY OTAL �
i hereb certi thot I ins ded the elechical installation described herein on the dates stated:
Rougirin Date
� � Investigative Fee � � L�� (�-L --� `��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
, OFFICE USE ONLY This request void 18 months from validation date printed in this box.
_:I���ii�auiiiiii�iiii��iiii�l � �"�
* � 9 3 6 9 0 0 0 * ����
PLEASE PRINT OR TYPE
Rough-in inspection required$ ❑ Yes No Inspection Ofher Than R ugh- Ready Now ❑ Will Call
You muzt call the inspector when ready Dafe Ready: M�y ���
I, �censed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: