P - 84205I �b4-900 e
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ,�
Home Duplex Apt. Bidg. Other. . f�Y h�� J
Commercial Industrial Farm �r
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back c
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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
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s usE oN�v TOTAL ,/ �(r
Sign/Oudine Lig. Xfmr. � ` ��
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ed fhe elecirical installation described herein on fhe dates stated
Irrigation Boom Rough-In Dare
Special Inspectio
Final
Investigative Fee —�- �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHtN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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y��- �� g pec eq ❑ Yes o Inspecfion Ofher Than RougfFln:
(You must call ihe inspecror when ready) Dafe Ready:
�.ticensed contractor ❑ owner hereby request inspection of the above electrical work at:
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