P - 82310REQUEST FOR ELECTRICAL INSPECTION
^}��(�(//�� �v�,� Minnesota State Board of Electricity 3
U����± �� dJ T 4� 1821 University Avenue Suite 5-128, Saint PaW, Minnesota 55104-2993 -
. (651) 642-0800 www.electricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusiria{ Farm Remod Repair
Air oner , Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesf. Enter remarks in this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspecfion Request will not be accepted withoui the correct fee:
Ofher Installations Fee # Service Enhance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. ���
Alarm/Remote Control
Swimming Pool
I he�eb certi fhat I ins fed fhe elechical insfallation described herein on the dafes stated:
Irriqation Boom Rouah-In �a�
Investigative F� � ti rrr �— `�
THIS INSTALLATION MAY BE ORDERED DISCON ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 1 S months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Requesh Dat� `Q� Rou h-in ins ction r uired8 ❑ Yes
g pe eq ❑ No Inspection Other Than Rough-In: eady Now ❑ Will Call
You must call the inspecfor when ready Date Ready:
I,�.licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: