P - 82551Ci��886-375 �
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 i���
(651) 642-0800 www.electricity.state.mn.us "�^
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air oner Htg. Equip. Water Hir. Load Mgmt. Ofher:
Dryer Range Elec. Heaf Temp. Service
"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 Inspecfion Fee - This Inspection Request will not be accepted without the correc�iee:
Other Installations 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. O,r
Alarm/Remote Control
Swimming Pool
I hereb cerfi fhaf I ins ected the elecirical insfallafion described herein on the dates stated:
Irrigafion Boom Rough-In . Dare
Special Jnspection
Final Da ��
Investigative Fee - � 2�'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins ecfion re uired?
J � —QO 9 p q ❑ Yes �o Inspecfion Other Than R=ugh-In: Ready Now ❑ Will Call
Vj�' You must call the inspector when ready Date Ready: ,�.�
1, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: