P - 80251.
REQUEST FOR ELECTRICAL INSPECTION
/1 � � � � � � � � � Minnesota State Board of Electricity
U 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ���:
. (651) 642-0800 www.electricity.state.mn.us '��'
Home Duplex Apf. Bldg. Other: New Addn
Commercial Industrial Farm emod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt Other:
Dryer Range Elec. Heat Temp. Service
"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 Inspec►ion Request will not be accepted without the correct fee:
Other Installations Fee #$ervice Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to T00 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
$ign / Outline Ltg. Xfmr.
Alarm/Remote Control "9 / Q
Swimming Pool ' /�s/%hLUi? � l� !�
I hereb certi that I ins ected the electrical installafion scribed he daf s�ta _ G�99
Irrigation Boom Rough-In Dare .
Special Inspecti r f — ��
Final Date % ,_ /_ ��
Investigative Fee ( [
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 1S MONTHS.
� OFFICE USE ONIY This requesf void 18 months kom validation date printed in fhis box.
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* 0 8 8 6 8 7 8 8* "�� 3
PLEASE PRINT OR TYPE
puest Date Rough-in inspection required2 �Yes ❑ No Inspection Olher Than Rough-In: ❑ Ready Now ill Call
�i /2 � You musf call the inspector when ready Date Ready: � .
� licensed conMactor ❑ company ❑ owner hereby request inspection of the above electrical work at:
b Address (Sheet, Box, or Roote No.) � _ City _ Zip Code
I Secfion
No.
Company Name _ _ � Conhactor License No. � Master Lic. No.
, Compony or Owner
, �ompan er rertormmg ��uatror� �,�� t� . rhone rvumber
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S ATE B PY SEE INSTRUCTIONS ON BACK OF YELLOW COPY