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P - 82326� REQUEST FOR ELECTRICAL INSPECTION � (� ����� p Z� � Minnesota State Board of Electricity 3 ��J Q 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 � (651) 642-0800 www.electricity.state.mn.us `�' w,RC N�w 14-f� Calculate Inspection Fee - 7his Inspecfion Request will not be Other Installations Fee # Service Enhance Size Fee Mobile Home Park Stall 0 to 200 Amps Street Ltg. / Traffic Sig. Above 200 Amps Transformer/Generator INSPECTOR'S USE ONLY Sign / Outline Ltg. Xfmr. Alarm/Remote Control Swimming Pool I herebvi certifv that I insoecfed the electrical i Special Insp€cRdrf� V' Final Investigative Fee THIS INSTALLATION MAY BE ORDERED IIII II III II I�I II III II III � III�>(11(� � I� � 0 9? 3 8 1 5 4* � without ►he wrrect (ee: Circuits / Feeders Fee 0 to 100 Amps d Above 100 Amps TOTAL �U,�O on the dates stated: DISCONIIECT� IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months from validation dafe printed in this box. � aa -� �a7� PLEASE PRINT OR TYPE Request Dafe Rough-in inspecfion required? ❑ Yes �No inspecfion Ofher Than RougMn: Ready Now ❑ Will Call � l/ �)p q I You must call the inspecfor when ready Date Ready: ��j ��j�n I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: