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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.electricity.state.mn.us
on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Enhance 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 ONLY TO L
Siqn / Outline Ltq. Xfmr. �O / L
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THIS INSTALLATION MAY BE ORDERED
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Requesf Date
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described herein on the dates stafed:
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DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: �Ready Now ❑ Will Call
You must call fhe inspecfor when ready Date Ready:
I, �[licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: