P - 82270, i �l(s �J:. . � `�� ���, �� �,� EST FOR ELECTRICAL INSPECTION � �� .�
J�_� � �� � � �. � ��i nesota State Board of Electricity
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' � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =
(651) 642-OS00 www.electricity.state.mn.us "'
"X" above ihe work covered by this request. Enter remarks in this space
Calculate Inspection Fee - This Inspection Request will not be
Ofher Installations Fee # Service Enfrance Size Fee
Mobile Home Park Stall 0 to 200 Amps
Street Lig. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I herebvi certify thaf I� inspected fhe elecfrical i
�pted wi►hout the correct fee:
# Circuits / Feeders Fee
� 0 to 100 Amps (z7
Above 100 Amps
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srared:
InvestigativeFee r�om �`��`���vare�� Z� C� I
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S monfhs from validation dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf D Rough-in inspecfion required? ❑ Yes No Inspecfion Other Than Rough-In: eady Now ❑ Will Call
� ' n � You must call the inspector when ready Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: