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
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(651) 642-0800 www.electricity.state.mn.us `�'
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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.
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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: