P - 82226REQUEST FOR ELECTRICAL INSPECTION
U� J,� I- 8 6 4 0 Minnesota State Board of Electricity �`3
" 1827 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 .-
� (651) 642-0800 www.electricity.state.mn.us " '
"X" above the work covered by this request. Enter
whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted withoui ihe correct fee:
Other Installations Fee # Service Entrance 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 TOTAL
mofe Control
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I hereb certi fhat I ins ted the electrical installation described herein on the dates stated:
Boom Rouah-In Date
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPIETED WITHIN 18 MONTHS.
OfFICE USE ONLY This request void 18 months (rom validation date printed in this box.
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PLEASE PRINT OR TYPE
. Requesf Daie Rough-in inspecfion required? ❑ Yes '�Jo Inspection Other Than Rough-In: ❑ Ready Now �ill Call
�"' $��' You must call fhe inspector when ready Date Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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