P - 82601� REQUEST FOR ELECTRICAL INSPECTION ��
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� 7821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 �^�
(651) 642-0800 www.electricity.siate.mn.us "��"'
ome Duplex Apt. Bldg. Other: New Addn
Commercial
Remod '"�"� Repair
I Air Conditioner I I Htg. Equip. I I Water Hfr. I I Load Mgmt. I Other. �" �
I Dryer I I Range Elec. Heat Temp. Service
"'� ove the work covered by this request. Enter remarks in this space and, on the back of the white copy only.
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Calculaie Inspection Fee - This Inspec�ion Request will not be accepted without the correct fee:
Other Installations Fee #k ervice Entrance Size - Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
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Sign / Outline Ltg. Xfmr. t� J. —7 �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dates stated:
Irrigation Boom Rough-In Dare
Special Insp ''
Final Date�- �
Investigative ee _ j y—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N T COMPLETED WITHIN 18 MONTHS _
� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT O TYPE
Requ st Date i Rough-in inspecfion required? ❑ Yes -� No Inspection Other Than Roogh-In: ,Ready Now � Will Call
���-\ ,�-`l�"� You must call the inspector when ready Da}e Ready:
1, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: