P - 82588REQUEST FOR ELECTRICAL INSPECTION
U� 9 71- 9 2 g� Minnesota State Board of Electricity �'
1821 University Avenue Suite 5-728, Saint Paul, Minnesota 55104-2993 ���
(651) 642-0800 www.electricity.state.mn.us `�m�
"X" above the work covered by this request. Enter remarks 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 Installafions 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 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dates stated:
Irrigation Boom Rough-In Dare
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� I Investigative Fee �`'"'� � / / o _ I vare�o _ �, � I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 8 months from validafion date printed in ihis box.
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PLEASE PRINT OR TYPE
Requesf Date Rou h-in ins ecfion required? ❑ Yes
9 P ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
��—'� ���X� You musf call fhe inspector when ready Date Ready:
I, �licensed contractor ❑ compony ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sfreef, Box, or Route I�o.) �' City Zip Code
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Section No. Township Name or No. Range No. Fire No. Counrv
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Power Supplier Address
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