P - 81092REQUEST FOR ELECTRICAL INSPECTION =
V��� �- 2 3 0� 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 Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Ofher Installations Fee # Service Entrance 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 TOTAL
Sign / Outline Ltg. Xfmr. °�O `�
Alarm/Remote Control
Swimming Pool I hereb certi fhat I ins ected fhe elechical installation described herein on the dafes stated:
I«iqation Boom _ _ Rouah-In Da�e
I � Investigative Fee � �
_ THIS INSTALLATION MAY BE ORDERED
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DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S monihs from validation date printed in ihis box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required? ❑ Yes �o Inspecfion Ofher Than RougMn: Q�.R�dy Now � Will Call
'a•� � S, Gj` Gr You musf call fhe inspector when ready Dafe Ready:
1, �Iicensed contractor ❑ company ❑ owner hereby request inspection of the above electricol work at: