P - 82314REQUEST FOR ELECTRICAL INSPECTION
� �� � � � � � � (� � � Minnesota State Board of Electricity �
� 1827 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us " '
"X" above the work covered by this request. Enter remarks in this space and on the
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Calculate Inspection Fee - This Inspection Request will not be accepted wifhout the correct fee:
Other Installations Fee # Service Enhance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTP�L
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereby certify fhat I inspected fhe
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Final
Investigative Fee = Z �- ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months (rom validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Re uest Date Rou h-in ins ection re uired? ❑ Yes
��� g p q ❑ No Inspection Other Than Rough-In: eady Now 0 Will Call
You must call the inspector when ready Date Ready:
I�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: