P - 81206REG�UEST FOR ELECTRICAL INSPECTION
U-��81-113 � Minnesota State Board of Electricity =
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ��:
(651) 642-0800 www.electriciry.state.mn.us `��'
"X" above the work covered by this request. Enter remarks in this space
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Colculate Inspection Fee - This Inspection Request will not be accepted witf�out the correct fee:
Oiher Installations Fee # Service Enirance Size Fce # Circuih / Feeders Fee
Mobile Home Park Stall 0 �0 200 Amps 0 to 100 Amps tE �
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. ti�F✓- �/ /s``� �Z�oSO
Alarm/Remote Control
Swimmina Pool . . . . . .. . . .. . . .
� Investigative Fee r�' I� C v — �� 7 � y– a�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requsst void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Da Rough-in inspection required$ ❑ Yes �lo Inspection Ofher Than Rough-In: �eady Now ❑ Will Call
�, i9 You must call the inspector when ready Dare Reody:
1, �icensed contractor ❑ company ❑ owner hereby request inspection of the above elechical work at:
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