P - 82299REQUEST FOR ELECTR�CAL INSPECTION
U� � � � � � � � � Minnesota State Board of Electricity
._ 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
�;� (651) 642-0800 www.electricity.state.mn.us `'�'
"X" above Ihe
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Calculate Inspection Fee - This Inspection Requesf will not be
Other Installations Fee # Service Entrance Size Fee
Mobile Home Pork Stall 0 to 200 Amps
Street Lig. / Troffic Sig. Above 200 Amps
TransFormerlGenerator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boflm .,. _ _
of fhe white copy only.
�pted without the correct fee:
# Circuifs / Feeders Fce
0 to 100 Amps
Above 100 Amps
TOTAL
i herebvi certifv that I insoected the elechical insfallafion described herein on fhe dafes sfated:
Investigative Fee F'��I ��L =--�— �p��b'-�� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.,
� OFFICE USE ONLY This requesf void 18 months 6om validation date printed in this box.
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* 0 9 8 8 3 6 9 5 * ��U`�' /
PLEASE PRINT OR TYPE
Request Date Raugh-in inspection requirad$ ❑ Yes ❑ No Inspection OSher Than Rough-In: �eody Now � Will Call
�-^ ��� p You must call fhe inspector when ready Date Ready:
I,J�.licensed contractor ❑ compony ❑ owner hereby request inspection of the above electrical work at: