P - 80359REQUEST FOR ELECTRICAL INSPECTION
(� � � � � � � 9 � � Minnesota State Board of Electricity
�'� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
" (651) 642-0800 www.electricity.state.mn.us "�'
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Wafer Hfr. 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 of the whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted withou► the correct fee:
Other Installations Fee # Service Enirance Size Fee # Circuifs / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps , OU
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTj�1Lu�t�D
Sign / Outline Ltg. Xfmr. � �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the elechical installation described herein on if�e dates smted:
Irrigation Boom Roo9h-i� oar�
$pecial Inspe ` � 7' �r
Final � �°fe�`T .O /
Investigative Fee �� 2" /
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monlhs (rom validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required2 �Yes ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now Will Call
'�.� 1S Q� You musf call fhe inspecfor when ready � Dafe Ready: �
j,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at