P - 826371 �� 15-265 DO � E
REQUEST FOR ELECTRICAL INSPECTION e���°� ..
Minnesota State Board of Electricity � g
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �`��... .__ F
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(651) 642-0800 www.electricity.state.mn.us �.��.�
Home Duplex Apt. Bltlg. 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 only.
N�P SAVER'S �WITCH
Calculate lnspection Fee - This Inspection Request will not be
nstallations Fee # Service Entrance Size Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
�.�JQ
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boo Rough In Date
Special Insp
Investigative Fee � F�nai _ oat ,,��
THIS INSTALLATION MAY. BE ORDERED D NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY�This request void 18 months from validation date printed in this box.
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Request Date y
PLEASE PRINT OR TYPE
Rough-In inspection required? ❑ Yes O N� Inspection Other Than Rough-In: r? Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I, [jdicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
-- "-"" """�°' SiA�E BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY