P - 82297REQUEST FOR ELECTRICAL INSPECTION ��
lJ � 9 5 4- 5 5 6�I 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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Calculate lnspection fee - This lnspection Reques► wiR no� be accepted withoul►he correct fee:
Ofher Installations Fee # Service Enfrance Size Fee #_. Circuits / feeders Fee
Mobile Home Park Stall 0 to 200 Amps to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generaror INSPECTOR'S USE ONLY TOTAL
Sign / Oudine Lfg. Xfmr.
Alarm/Remote Control
Swimming Pool
I here
Irriaation Boom o....,.
Date
rinai f��� I U��� � "'f
Investigafive Fee _��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 monihs from validation date printed in this box.
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PLEASE PRINT OR TYPE
Re uest Date Rough-in inspection required? ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now�ill Call
0 o You must call the inspector when ready Date Ready:
I,�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: