P - 82379����6-451 �l
Dryer � IRange
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55t04-2993 ��:
(651) 642-0800 www.electricity.state.mn.us "�'
Apt. Bldg. Other:
Farm
Water Htr. Load Mgmf.
Repa i r
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entra�ce Size Fee # Circuits / Feeders
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 TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I here
Irrigation Boom Roog
Special Inspeii�iQ � � _ .
described herein on the dates
Dafe
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN
OFFICE USE ONLY This requesf roid 18 months from va�id tio
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* 0 9 8 6 4 5 1 3*
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8 MONTHS.
printed in this box.
PLEASE PRINT OR TYPE
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: