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Home Duplex
Commercial Industri
Air Cond. Hta. Ec
"X" above the work
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on
New
Remod
of the white copy
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Calculate Inspection Fee - This Inspeciion Request will noi be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Tra�fic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�r TOTAL
Sign Oudine Ltg. Xfmr.
^ ,
Alarm/Remote Control
Swimming Pool
� I hereb certi ihat I ins fed the electrical installation described herein on the dates stated
Irrigation Boo C' Rough-In Date
Fee
Investigative Fee "'�' - � � '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ON�Y This request void 18 monihs from validation date printed in fhis box.
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Request Dafe Rou h-in ins ection r uired?
9 p eq ❑ Yes No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call
i�.� ��—�G� (You musf call the inspecPor when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the atiove electrical work at:
lob Address �Sheet, Box, or Route No.) Ciy Zip Code
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Section No. Township Name or No. Ranqe No. Firc No. Countv ..
Name
��ce.ec�..a�rc.
�w....w �.� � r o� ro � STATE BOARD COPY - SEE INS'
Phone �o.� � _ ^ � � I
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