P - 82540REQUEST FOR ELECTRICAL INSPECTION � �� �
� � � � �� � � � � Minnesota State Board of Electricity ��4 �
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J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �"�P ��
_1 (651) 642-0800 www.electricity.state.mn.us
Duplex
Air Conditioner Htg. Equip.
Dryer Range
"X" above the work covere
Apt. Bldg. Other: New
Farm Remod
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
is request. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installafions Fee # Service Entrance Size Fee # Circuifs / 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 TOTA
Sign / Outline Ltg. Xfmr. • `� "
Alarm/Remote Control
Swimming Pool
I hereb certi ihaf I ins ecied fhe electrical instellation described herein on the dates stated:
Irrigation Boom Rough-In Dafe
Special Inspection
Final �
Investigative fee '
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 8 MONTHS.
OFFICE USE ONLV This request void 1 8 months from validation date printed in this box.
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PLEASE PRINT OR YPE
Requesf Dafe '� �� Rough-in inspection required? ❑ Yes No Inspection Ofher Than Rough-In: Ready Now ❑ Will Call
You musf call fhe inspector when ready Dafe Ready:
1, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo Addr ss (Sfreef, Box r Roufe No.) City Zip Code
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Section No. Township Name or No. Rang o. Fire No. C n�����
Occupanf
Power
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Company or
ing
Phone No.
� License No. Master Lic. No.
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Phone
STA7� BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY