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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
Apt. Bldg. Other. e�
Farm Rem
Water Htr. Load Mgmt. Other:
Dryer I I Range I I Elec. Heai I I
"X" above the work covered by this request. Enter
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Calculate Inspection Fee - This
Other Installations Fee # :
Mobile Home Park Stall �
p. Servii
in this space and on �he back of the white copy
Requesi will no► be accepted without ihe correct fee:
�ce Size Fee # Circuits / Feeders Fee
— 0 ro �Ob Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. �c�c�� V��^ (� _� � 0' Sv
Alarm/Remote Control "��
Swimming Pool
I hereb certi that I ins ted the electrical installation described herein on the dafes stared:
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� � Investigative Fee ' � �' � � �" � � `'�""`,i�--�"'" �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPL EI3'WITHIN 18 MONTHS.
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OFFICE USE ONLY This requesf void 18 monfhs bom validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required? ❑ Yes �lo Inspecfion Ofher Than Rough-In: �ady Now � Will Call
— `l ` Q Q You must call the inspector when ready Date Ready:
I, i�%licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: