P - 82070REQUEST FOR ELECTRICAL INSPECTION �
7 },^�( Q Minnesota State Board of Electricity �'
U.� �� 1� 0 V �+ � t821 U�iversity Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 ���
,, (651) 642-0800 www.electricity.state.mn.us "�'
"X" above ihe work covered by this reqvest. Enter remarks in fhis space and on me back ot
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Calculaie Inspection Fee - This Inspection Request will nof be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuiis / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Am s
Transformer/Generator INSPECTOR'S USE ONLY TOTAL,,
Sign / Outline Ltg. Xfmr. '
Alarm/Remote Control
Swimming Pool
I hereb certi thaf t ins ected the elecfrical insta�lation deuribed herein on fhe dates sta
Irriqation Boom Ro„ah-i„ Da�e
Fee
30
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� � Investigative Fee i"'+' � �_„i� -j /-�5 '"�' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request wid 18 months from validation date prinfed in fhis box:
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* 0 8 6 7 0 8 9 5�
Requesf Dafe Rough-in inspection required$ ❑ Yes
4� � e�- � � You must call the inspector when ready
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PLEASE PRINT OR TYPE '
Inspecfion Ofher Than RougMln: ❑ Ready Now �Will Call
Date Ready:
I, �;licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: