P - 81826REQUEST FOR ELECTRICAL INSPECTION �
(1 - 9�5 3- 0 7 5� Minnesota State Board of Electricity �^ �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
• (651) 642-0800 www.electricity.state.mn.us `���
Calculate
Mobile Home Park Stall
Street Ltg. / TraFfic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool i
irrigation Boom
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ite copy only.
Fee - This Inspection Request will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits / Feeders Fe
0 to 200 Amps 0 to 100 Amps
Above 20 Amps B Above 100 Amps
INSPECTOR'S USE ONLY TO
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I hereb ceAi fhat I ins ted the elechical installation described herein on ihe dates stated:
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I � Investigative Fee � � � ��.��-- – � f/—/ �(
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validation date prinfed in this box.
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�O PLEASE PRINT OR TYPE
contractor ❑ company ❑ owner
SEE INSTRUCTIONS ON BACK OF YELLOW COPY