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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 � b ��� c�SI �� �`1— � �8� 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. IiINNIII��IliiiilHIIIIII�IUII�C�I�f � +� * 0 9 8 8 7 7 5 3* ,�F ��� # � 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�