P - 82229REG�UEST FOR ELECTRICAL WSPECTION °'�
U� 9 6?��`) � � Minnesota State Board of Electriciry
. � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
� ` � (651) 642-0800 www.electricity.state.mn.us "��
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Calculate Inspection Fee - This
Other Installations Fee # ;
Request will not be accepted without the correct fee:
Mobile Home Park Stall 0 to 200 Amps
Sfreet Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltq. Xfmr.
� Pool
Boom
# Circuits / Feeders
0 to 100 Amps
Above 100 Amp:
TOTAL
28UJ
tion described herein on fhe dates sf
Date
. • Finql I Date I
Investigative Fee
THIS INSTAlLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONIY This request void 18 monihs from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required? ❑ Yes ❑ No Inspecfion Other Than Rough•In: Ready Now ❑ Will Call
`-' � -��O You must call }he inspecfor when ready Date Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: