P - 83122602°�66 �
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
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Commercial Industrial Farm ✓,�d ��--1 Remod Re ai
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter rema ks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be 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
Transformer/Generator INSPECTOR'S USE ONLY TOTA /�
Sign/Oudine Ltg. Xfmr. J
Alarm/Remote Control
Swimming Poel
I hereb certi that I ins cfed the elechical installafion described herein on the dates slated
Irrigation Boom RougMn Dare
Special Inspecti
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCO TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion dale printed in this box.
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P EASE PRINT OR TYPE
(°� Rough-in inspection required? ❑ Yes o Inspecfion Ofher Than RougMn:
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censed contractor ❑ owner hereby request inspection of the above electrical work at:
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Now ❑ Will Call
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�ATE B / OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY