P - 82090� -
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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.e/ectricity.state.mn.us :- `
X Home Duplex Apt. Bidg. 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 this space and on the back of the white copy on/y.
Ca/cu/ate Inspecti<
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
N3P 3AVER'3 3WITGH
Fee - This Inspection Repuest will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In �
without the correct fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL
.�
dates
L � Investigative Fe'e ��' }' -1 � w � �(/� ��'� 2���(3'i— �
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
___.__„-�,_._.._ .,....,.�_.._-.._._.,.,...,_.„„,„.„.„,,,...., „„,„,,,...•-OFFICE USE ONIY This request void 18 months from validation date printed in this box.
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*Q8598179* �5�t13
PLEASE PR1NT OR TYPE
Request Date
Rough-In inspection required? ❑ Yes C] t� Inspection IJthenThan Rough-In: �?eady Now � Will Call
�!h d�m You must call the inspector when ready! Date Ready:
I, g] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: