P - 82373REQUEST 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 "'
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Calculate Inspe
Other Installations
Mobile Home Park Stall
Sireet Ltg. / Traffic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriqation Boom
Fee - This Inspection Reques► will not be accepted without the correci fee:
# Service Enfrance Size Fee # Circuits / Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTnAL
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herein on the dates stated:
Final � � � I Qefe^ ��s �
Irnestigati � ------�._.- �Q
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs 6om validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Reque�sf9D,afe Rough-in inspection required$� ❑ Yes ❑ No Inspecfion Ofher Than Rough-In: eady Now ❑ Will Call
�'� --a a You musf call fhe inspetfor when ready Dafe Ready:
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: