P - 81197— �
REQUEST FOR ELECTRICAL INSPECTION
0_854'�2 I � Minnesota State Board of Electriciry
�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us ' : '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspecti�
Jther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransiormedGenerator
Sign / Outline Ltg. Xfmr.
Fee - This Inspection Request will not be
�e # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
vted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL �
ao
" I hereby cert' that I ins cted the electrical installation described herein on the dates statad:
Irrigation Boom Rough In Date
i� Special Inspection a
Investigative Fee Finai teZ ` ^ �
THIS INSTALLATION MAY BE ORDERED DI ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than Rough�ln: ❑ Ready Now � Will Call
�,� You must call the inspector when ready� Date Ready: ��
I, []Gicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: