P - 82595�-957-6?_4 �
REQUEST F LECTRICAL INSPECTION
Minnesot ard of Electricity ; '���
1821 Univers Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 '�'
(651) 64 -0800 www.electricity.state.mn.us ��` ���'��
'Flome Duplex Apt. Bldg. Other: New
Commercial Indusirial Farm Remod
Air Conditioner Htg. Equip. Water Htr. Load MgmL Other.
Dryer Range Elec. Heaf Temp. Service ' y�
"X" above the work covered by this request. Enter remarks in this spac and on ihe back of the white c
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Calculafe Inspeciion Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Insfallations Fee # Service Entrance Size Fee # Circuits / Feeders
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. /�//— �' 1'' `� ��q
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dates stal
Irripation Boorb`; .'� e =.- o,.....�. �.. „_._
0
Fee
5�
Special Inspec?kSnv � e) �
Final D
Investigative Fee
_THIS INSTALLATIQN MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in fhis box
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PLEASE PRINT OR TYPE
Dafe Rough-in inspecfion required? ❑ Yes ❑ No Ins ecfion Other Than Rou h-In: ead Now
�^ `� P 9 y ❑ Will Call
C You must call the inspector when ready Date Ready:
I,�S"censed contractor ❑ company ❑ owner hereby request inspection of the above electrical wnrk �+•