P - 81594REQUEST FOR ELECTRICAL INSPECTION �°'E
�� ('� � � � � � [ � Minnesota Staie Board of Electricity
J J 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us "�'
Calculate Inspection Fee - This
Mobile Home Park Stall
Street Ltg. / Traf#ic Sig.
Tra nsformer/Generator
Siqn / Outline Ltq. Xfmr.
3 Pool
Boom
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Inspection Request will not be accepted without the correct fee:
iervice Entrance Size Fee # Circuits / Feeders
0 to 200 Amps 0 fo 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTA�i
I herebvi certifv that I insoecfed the elecfrical installation
Date
Investigative Fee D(�U `E' �—
THIS INSTALLATION MAY BE ORDERED DI PIECTED IF NOT COMPLETED WITHlN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in this box.
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� 3O PLEASE PRINT OR TYPE
Requesf D te Rou h-in ins ction r uired?
�g pe eq ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
You must call the inspecror when ready Dare Ready:
1 licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
a�t��c oVNnu VVri ,CC INSIRU{;IIUIVS VIV tlAI:R VF TtLWW I:UY�