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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.electricity.state.mn.us `��
e work covered by ihis reques Enfer remarks in �his space ond on
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culaie Inspection Fee - This Ins�o'�i Kequest wi not be accepted without the correct fee:
Fee
Other Installations Fee # Service,Entrance Siz � Fee Circuits / Feeders
Mobile Home Park Stall 0 to 00 Amps to 100 Amps
Street Ltg. / Traffic Sig. Abo e 200 Amps bove 100
TransFormer/Generator INSPECTOR'S USE ONLY TC
n / Outline Ltg. Xfmr.
rm/Remote Conhol
Boom
that I ins ted the elecfrical installation described herein on the dates stafed:
Date
� Imestigative Fee � � � j�,J�-��j—�/( �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This requesf void 18 months from validation date printed in }his box.
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'j�o�• �O PLEASE PRINT OR TYPE
iquest Date Rough-in inspection required? ❑ Yes � o Inspection Other Than Rough-In: �Ready Now � Will Call
���/�G/ You musf call fhe inspector when ready Dofe Ready: .
❑ licensed contractor ❑ compony ❑ owner hereby request inspection of the above electrical work at: ,