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Air Conditioner Htg. Equip.
Dryer Range
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REQUEST FOR ELECTRICAL WSPECTION
Minnesota State Board of Electricity a
1821 University Ave�ue Suite S-128, Saint Paul, Minaesota 55104-2993
(651) 642-0800 www.e%ct�icity.state.mn.us
Apt.
Farm Remod Repair
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
is request. Enter remarks in this space and on the back of the white copy oniy.
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Calculate Inspection Fee - This Inspection Request wii� not be accepted without the correc� fee:
Ofher Instollafions Fee # rvice Entrance 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
Transformer/Generator INSPECTOR'S USE ONLY TO
Sign / Outline Ltg. Xfmr. � � �
Alarm/Remote Control
Swimming Pool _
I hereb cerli That f ins ected the elechical insmllation described herein on the dales smted:
Irriqation Boom * ) a�„oh.i� oore
� � Investigative Fee � � � /�'l6"�/ )
THIS INSTALLATION MAY BE ORDERED DISCONNECTEO IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 monfhs from validafion date printed in ihis box.
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Rough-in inspection required� ❑ Yes �
�� d You must call the inspecror when ready
PLEASE PRINT OR TYPE
Inspecfion Ofher Than Rough-In: ❑ Ready Nc
Date Ready:
j,�, ✓icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: