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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551p4-2993
(651) 642-0800 www.electricity.state.mn.us
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Commercial Indusirial Farm
Air Conditioner Hfg. Equip. Water Htr. Load Mgmf.
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enter remarks in thi;
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Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Installations Fee # Service Enhonce Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall ( 0 to 200 Amps 3l�• 0 to 100 Amps `
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Outline Ltg. Xfmr.
Remote Control
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the eleckical installation described herein on fhe dates stated:
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Investigative Fee F�nal / ,/� I Da� Y ZCJ,tp c'�
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This request void ) 8 months bom validption date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In� dy Now ❑ Will Call
��. �� You must call the inspector when ready Date Ready: � .
I,�censed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or Roufe No.) City � Zip Code
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Section No. Township Name or No. fire No. uny � �
Occupant
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�Contractor, Company or Owner
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Phone No.
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY