P - 82250REQUEST FOR ELECTRICAL INSPECTION �`�E
�—� 1 4-832 �8 Minnesota State Board of Electricity -- '3
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 : _
(651) 642-0800 www.electricity.state.mn.us . '
v Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y.
Ca/cu/ate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom � _
NSP �AVER'S SWITCH
Fee - This Inspection Request will not be
se # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
0 to 100 Amps
Above 100 Amps
TOTAL
�.�J' �
I hereby certity that I inspected the electrical installation described herein on the dates
Rough In Date
Investigative Fee r� � �� -- �� �.—�% I
THIS INSTALLATION MAY BE ORDERED DISC D IF NOT COMPLETED WITHIN 18 MONTHS.
. .......... .....� .......................................... . ..�,�., . . _.... .�t
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I IIIII) IIIII IIIII IIIII IIIII III IIIII IIII I�I OFFlCE USE ONLY This request void 18 months from validation dat� n� in th�x.
* 1 0 1 4 8 $* • �/���
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ Nf� Inspection Other Than Rough-In: � Ready Now ❑�II Call
y...__ ,�y,.y ,yvy� You must rall the inspector when ready! Date Ready:
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: