P - 81588,
�.r004-013
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REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota State Board of Electricity
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 Inspection Requesi will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fce
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL sG
Sign / Outline Ltg. Xfmr. � . �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the electrical installation described herein on the dates stated:
Irriqation Boo Q C �.� R„���h_I„ Date
I Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED
Iu��1lIIIIIIIIII) IIIII (I������
* 1 0 0 4 0 1 3 7*
� -� � °a�2_ $`-��9d
DISC _ TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S months from valida��(te�printed in ihis box.
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PLEASE PRINT OR TYPE
Rougirin inspection required? ❑ Yes o Inspection Other Than Rough-In: eady Now ❑ Will Call
You musf call the inspecfor when ready Date Ready: �
1, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: