P - 82576n
R REQUEST FOR ELECTRICAL INSPECTION �'�°
�'0 ��_"�� � Minnesota State Board of Electricity F'-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �'� _�
(651) 642-0800 www.electricity.state.mn.us ,��.
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� Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
fVSP �AVER'� �WITGFi
Fee - This lnspection Request will not be
�e # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
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�ted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
cQ. �
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
Investigative Fee Final / pac� ��� c�
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
............................................................................................................................................... . .......................................................................
II I IIIIII IIIII IIIII IIIII IIIII II I IIIII IIII IIII OFFICE USE ONIY This request void 18 months from validation date printed in this box.
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* 1 0 1 4 8 7* �����,
PLEASE PRINT OR TYPE
Request Date
Rough-In inspection required? ❑ Yes ❑ NA Inspection Other Than Rough-In: � Ready Now ❑ Will Call
�� �nQ •�� •x�1Xti You must call the inspector when ready! Date Ready:
I, [�iicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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