P - 81735REQUEST FOR ELECTRICAL INSPECTION ��
U��� �� 7 4 2� Minnesota State Board of Electricity 3
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -
�' (651) 642-0800 www.electricity.state.mn.us `' '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Lood Mgmi. Ofher: /�r
Dryer Range Elec. Heat Temp. Service �qaX,vaeq� �C4'u��' �rVl,�`^�t1 `
"X" above �he work covered by this reqvest. Enier remarks in this space and on the back of he white o�,p�nly.
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Calculate Inspection Fee - This Inspection Requ t ill ot be accepted without the co rect fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall � 0 to 00 Amps �! 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generafor INSPECTOR'S USE ONLY TO�TA�rL ��
Sign / Outline Ltg. Xfmr. tP� '
Alarm/Remote Control
Swimming Pool
I hereb certi fhaf I ins fed the elechical ins ofion described herein on ihe dafes sfated:
Irrigation Boo RougMn Date ��/
Special Inspe �
Final + �� �U
Investigative Fee J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI HIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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* 0 8 6 0 7 4 2 6 * �0 ScS�Z�
PLEASE PRINT OR TYPE
Request Date Rough-in inspectio� required? � es ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now '�11�1 Call
��. �,j 0 l You must call the inspecfor when ready �Dote Ready:
I, �censed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: