P - 82300REQUEST FOR ELECTRICAL INSPECTION -
� �� � � � � � � � Minnesota State Board of Electricity �
1821 Universily Avenue Suite 5-128, Saint Paul, Minnesota 55704-2993 ���:
• (651) 642-0800 www.electricity.state.mn.us "'
Home Duplex Apt. Bldg. Other: New ddn
Commercial fndustrial Farm Remod Repair
Air C " ne Htg. Equip. Water Htr. Load Mgmf. Ofher:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Requesi will not be accepted without fhe correct fee:
Other Installations fee # Servic� Enhance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps CY7
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL��
Sign / Outline Ltg. Xfmr.
Alarm/Remote Contro{
Swimming Pool
i hereb certi thaf I ins cfed fhe electrical insfallafion described herein on the dafes sfated:
Irriaation B � t: � R����ti_i„ Dare
Investigative Fee r��� ( �Q �,3— a�-
THIS INSTALLATION MAY BE ORDERED DI NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs kom validafion dafe prinfed in ihis box.
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PLEASE PRINT OR TYPE
Request Dafe j Rough-in inspection required? ❑ Yes �o Inspecfion Ofher Than Rough-In: ❑ Ready Now ❑ Will Call
�/ %/�a('� You must call the inspecror when ready Date Ready: /��/�
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I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: