P - 82068REQUEST FOR ELECTRICAL INSPECTION
�'� ��� Q� � Minnesota State Board of Electricity
� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone (612) 642-0800 `'�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. 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 whiie copy only.
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Calc av( te Ins� pection Fee - Thi�iion Request wil�e accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps ��i
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �r�
Alarm/Remote Confrol
Swimming Pool
I hereb certi fhat I ins ted the elechical installation described herein on the dates staled
Irrigation Boom Rough-In Date
Special Inspecti
Final Dqt�—
Investigative Fee V
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIM 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation dqfe prinfed in this box.
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LEASE PRINT OR TYPE � �
Reque Rough-in inspecfion requi�ed$ ❑ Yes o Inspecfion Other Than RougMn: eady Now ❑ Will Call
�f Q� (You must call the inspecfor when readyJ Dafe Ready: .
I, li'censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job ress �Street, Box, or oure No.) � Ciy / Zip Code
/00� �fi> �
Secfion No. Township Name or No. Range No, Fire No. Couny ��
� Occupanf � � � Phone No.
or Owner Performing Insfallafionj S�U�`
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�r or Owner PerForming Installafion) ,(� Phone No.
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STATE 80ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY