P - 81545REQUEST FOR ELECTRICAL INSPECTION
�/}y( //'� � Minnesota State Board of Electricity �'
�� V���� L� �+Crv� 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:
Other Insfallafions 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 TOTAL
Sign / Outline Ltg. Xfmr. �1. � ��
Alarm/Remote Control �v1`�`r
Swimming Pool
I hereb certi that I ins cted the elechical instailation described herein on the dates sfated:
Irrigation Boom .. Rough-I� Dare
Special Inspec '
Date
Investigative Fee � f - ,� --� ,3
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS.
i OFFICE USE ONLY This request void 18 months (rom validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required8 ❑ Yes �lo. Inspection Other Tha`n Rough-In: Ready Now � Will Call
�`' f�bO You must call the inspecfor when ready Date Ready: , 1.� 2,� OQ
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I, � licensed contractor ❑ company ❑ awner hereby request inspection of the above electrical work at: