P - 82293REQUEST FOR ELECTRICAL INSPECTION ���
i1 s C% 0� 0 O/� � Minnesota State Board of Electricity !3
��� �� `t 1821 University Avenue Suite S-128, Sain[ Paul, Minnesota 55104-2993
.- (651) 642-0800 www.electricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repoir
Air Condifioner Htg. Equip. Water Hh. Load Mgmt. Other.
Dryer Range Elec. Hea1 Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied without the correci fee:
Other Installations Fee # Service Enhance 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
TransformerJGenerator INSPECTOR'S USE ONLY TQr,T,{�IL
Sign / Outline Ltg. Xfmr. "t�.
Alarm/Remote Control
Swimming Pool �
I hereb certi that I ins ected the electrical installation described herein on the dates staled:
Irrigation Bo � Rough-In �af
Speciallnspe o 1��a
Fi�ml Date �.! G,�
Investigative Fee � a
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�` � OFFICE USE ONLY This requesf void 18 monfhs from validafion dafe prinied in�fhis box.
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PLEASE PRINT O TYPE
Request Dafe Rough-in inspecfion required8 �Yes ❑ No Irtspection Otheer�T n R ugh-In: dy N
� � 2 .— � You musf call the inspector when ready Date Ready: /��O d
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: