P - 82609���'�-`�1 1 u C'' ��"( C�� G��EQUEST FOR ELECTRICAL INSPECTION
�1 � � C �i � � Q � � Minnesota State Board of Electricity � �
.:1 o L c� 1g21 University Avenue Suite S-128, Saint Paul„Minnesota 55104-2993
` (651) 642-0800 www.electricity.state.mn.us "���='°�
copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size fee #. Circuits / Feeders e
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 TOT
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ecfed the electrical insfallation described herein on the dafes stated:
Irrigation Boo Rough-In �a�e
Special Inspec ion .
Final �
investigative Fee � Z��'�?
THIS INSTALLATION MAY BE ORDERE CTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This requesf void 1$ months from validation date printed in this box.
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Re uest Dafe
PLEASE PRINT OR YPE
L!�� / I '� Rough-in inspection required? ❑ Yes � No Inspecfion Ofher Than Rough-In: ( Ready Now ❑ Will Call
.� �� _`-\`% You must call the inspector when ready Dafe Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sfreet Box, or Ro te No.J...... �
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Section No. Township Name or No. Range No. Fire No. County,.,�
Power Sup� �ier �
fncal Confractor / C
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ailing Address Coptra
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� pany or Owner Performing
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STATE BOARD COPY
Phone
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.ontractor License No.
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ster Lic. No. (Planf Elect. Onl�
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