P - 80349� � �REQUEST FOR ELECTRICAL INSPECTION ��
(1 � � � 4 - �. O `� � Minnesota State Board of Electricity �
�J � 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 .
(651) 642-0800 www.electricity.state.mn.us "�"
Calculate Inspec►ior
Other InstallaHons Fee
Mobile Home Pork Stall
Street Lig. / Traf#ic Sig.
Tronsformer/Generotor
Sign / Outline Ltg. Xfmr.
Alorm/Remote Control
Swimminp Pool
copy only.
Fee - This Inspection Request will not be accepted without ►he correct fee:
# Service Enirance Size Fee # Circuits / Feeders Fae '1
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTA� �
C�( � ���� ��
I herebvi certi(v ihat I insoected the electrical installotion
Imestigative Fee `--<--�C-'
THIS INSTALLATION MAY BE ORDERED DISC ED IF NOT COMPLETED WITHI 18 MONTHS.
!^ ^ OFFICE USE ONLY This requesf void 18 monfhs from validation date printed in ihis box.
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* 0 9 2 4 1 0 3 5 � ��D �`�'
PLEASE PRINT OR TYPE
R uesf Dafe �` Rough-in inspection required$ ❑ Yes � No Inspection Other Than RougMn: Ready Now � W��I Call
� �� You must call the inspector when ready Date Ready:
j,�censed contractor ❑ company ❑ owner hereby request inspection of the above elechical work at: