P - 82401REQUEST FOR ELECTRICAL INSPECTION
��� o.7 - 3 3 8� Minnesota State Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ���i
- (651) 642-0800 www.electricity.state.mn.us "'
' Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. 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 Inspection Fee - This Inspecfion Request will no� be
Ofher Installations Fee #$ervice Enhance Size fee
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi fhof I ins cted fhe elechical insfallafion
{rrigation B Rough-in
� without the correcf fee:
Circuih / Feeders fee
0 to 100 Amps
Above 100 Amps
TOTAL
,�1 �L
Investigative Fee Final �/�'—�� Q—_ I ua �
C
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from vafidation date pr' i thi box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes ❑ No Inspection Ofher Than RougMn: Ready Now ❑ Will Call
�� —��� You must call fhe inspector when ready Dafe Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: