P - 80392REQUEST FOR ELECTRICAL INSPECTION
� 0 � � � � � � � � Minnesota State Board of Electricity � "
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ��i
(651) 642-0800 www.electricity.state.mn.us `'�'
Commercial Industrial Farm NeW SGrYf GQ runC.( Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in this space a�d on the back of the white copy only.
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Calculate Inspection Fec - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits j Feeders Fee �
Mobile Home Park Stall 0 to 200 Amps OipO to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT
Sign / Outline Ltg. Xfmr. �
Alarm/Remote Control y�j p
Swimming Pool
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I herebvi certifv that I insoected fhe elechical instalbtion deuribed herein on the dates stated: i
Imestigative Fee � / �-- � � 2� �U
THIS INSTALLATION MAY 8E ORDERED NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs (rom validafion dafe printed in fhis box.
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PLEASE PRINT OR TYPE
quesf Date Rough-in inspection required? ❑ Yes ,��IVo Inspeciion Ofher Thon Rough-In: Ready Now 0 Will Call
'� ��..�(, You musf call the inspecror when ready Date Ready: �^ ��n
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above elechicaf work at: