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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 "�'
afer Htr. Load Mgmt. Other:
ac. Heat Temp. Service
request. Enter remarks in this space and on
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Calculate Inspection Fee - This Inspection Request will not be accepA
Other Insfallafions Fee # Service Entrance Size Fee #
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY .
Sign / Outline Ltg. Xfmr. `� p-t�;.-t.�G;,er ,
Alarm/Remote Control "
Swimming Pool �J����
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I herebvi certifv fhaf I insoected fhe elecirical insialla}ion
copy only.
� without the correct fee:
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL _
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Special InspeEll�ori U fa .
Final . Dote� ��
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCOMNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
" � � OFFICE USE ONLV This requesf void 18 months from validafion dafe printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection requiredZ Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now ill Call
a��� O� You must call the inspecfor when ready Date Reody: �
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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