P - 82331REQUEST FOR ELECTRICAL INSPECTION
� G� g 4�(� �� � Minnesota State Board of Electricity
�� 1827 University Avenue Suite 5-128, Saint Paul, Minnesota 55704-2993 �;
' (651) 642-0800 www.electricity.state.mn.us
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Calculate Inspection Fee - This Inspection Request will not be
Ofher Installations Fee # Service Entrance Size Fee
Mobile Home Park $tall 0 fo 200 Amps
$treet Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Oudine Ltg. Xfmr. N�
Alarm/Remote Control � r'� �
Swimming Pool
I herebvi certiH that I insoected the elechical i
copy only.
spted without the correct fee:
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL _
•rmoi d+Z
Investigative Fee �—" % — �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1S MONTHS.
f_ , _ — -- ---- —. .� __ __ _- -- — --- ------- �----a—
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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* 0 9 9 4 0 7 9 2* �3�`�'
PLEASE PRINT OR TYPE
Requesf Date ^oO Rough-in inspection required$ ❑ Yes ❑ No Inspecfion Other Than Rough-In: eady Now � Will Call
+ You musf call ihe inspector when ready Dafe Ready:
I,�.licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: