P - 82334REQUEST FOR ELECTRICAL INSPECTION �
U�, (� � C� 4� ry � Minnesota State Board of Electricity
.7 C� 1 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 �i
(651) 642-0800 www.eleciricity.state.mn.us
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"X" above the work covered by this request. Enter remarks in
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Calcula►e
Mobile Home Park Stall
Streef Ltg. / Traffic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr
Alarm/Remote Control
Swimmina Pool
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Fee - This Inspection Request will not be accepted without ihe correci fee:
# Servica Enhance Size Fee # Circuits / Feeders Fee
0 to 200 Amps j 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
D.
I herebvi certi(y ihat I inspecfed the elechical installation described herein on the dales stated:
- rinal var ��
Investigative Fee �
THtS INSTALLATION MAY BE ORDERED'DISCONNECTED IF NOT COMPLETED WITHIN 8 ONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
. Requesf Date . Rough-in inspection required? ❑ Yes Jy�°1��N'o Inspection Ofher Than Rough-In: � Ready Now � Will Call
� O� You must call the inspector when ready ( Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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