P - 82041REQUE T OR ELECTRICAL INSPECTION �T"E�
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(� s � � � � � � /� � Minnesot tat Board of Electricity �:g
lJ �t 1821 Unive ity nue Suite S-128, Saint Paul, Minnesota 55104-2993
�� (651) 6 -OS00 www.electricitystate.mn.us '��'
"X" above ihe work covered by this requesf. Enier remarks in ihis space
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Calculate Inspection Fee - This Inspe�ction Request will not be accepted without the correct fee:
Other Insfallations Fee # Service Enhance Size Fee # Circuits / feeders
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 TOTAL
Sign / Outline Ltg. Xfmr.
Alprm/Remote Control
tiH that I insoected the electrical
Investigative Fee r�oai �� I va�� Z�,.�
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THIS INSTALLATION MAY BE ORDERE4 DtSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from volidafion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required$ ❑ Yes �}Jo Inspecfion Ofher Than Rough-In: �Ready Now � Will �Call
3 '� You musf call fhe inspector when ready Dafe Ready:
1, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: