P - 82294�����6-549 �I
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
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Calculaie Inspection Fee - This Inspection
Other Installations Fee # Service En}ra
Mobile Home Park Stall 0 to 200
Street Ltg. / Traffic Sig. Above 20
Transformer/Generator INSPECTOR'
Sign / Outline ltg. Xfmr.
Alarm/Remote Control :
Swimming Pool
1 hereb certi that
Irrigation Boom Rouyha�
Special Inspecti !,► t' ; -
ite copy only.
Request will not be accepfed withouf the correct fee:
nce Size Fee # Circuifs / Feeders Fee
Amps 0 to 100 Amps �,
0 Amps Above 100 Amps
S USE ONLY TOTAL� D
the electrical installation described herein on the dates stated:
� Imestigative Fee � � � �- x-'''v I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�OPFICE USE ONLY This requesf void 18 monfhs from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date ' Rough-in inspection req�ired8 ❑ Yes �o Inspection Other Than Rough-In: ❑ Rea Now Q Will Coll
7 p� � You musf mll the inspecfor when ready Date Ready: ��� �
1, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: