P - 82317REQUEST FOR ELECTRICAL INSPECTION � �
U� a/; ���� C � Minnesota State Board of Electricity
v�� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 �.
� (651) 642-0800 www.electricity.state.mn.us `' '
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Enkance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONIY TOTAL
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fed the electrical installation desctibed herein on the dates stated: '
Irripation Boom Rouah-In �a�
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Investigative Fee � v
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHI 18 MONTHS.
� OFFICE USE ONLY This request void 1 S months from validation dafe printed in this bo
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PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes '�lo Inspection Other Than Rough-In: ❑ Ready Now �/ill Call
�/��7 You must call the inspecror when ready Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: