P - 82256REQUEST FOR ELECTRICAL INSPECTION `���
�1 �� p� o� p� � Minnesota State Board of Electricity �q� �
<<� 0 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �
(651) 642-0800 www.electricity.state.mn.us '��'
"X" above the work covered by this request. Enter remarks in thi
R��O � r��� �-j�.
Calculate Inspection Fee - This
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Tra nsformer/Generotor
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
�
Request will not be
ce Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certi(v thaf I
������
=pted without the correct fee:
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
herein on fhe dates sfated:
THIS INSTALLATION MAY BE ORDERED DISCZf'R IF�ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S months from validation dafe prinfed in this box.
_ III�R���l���lll����l��iil��l� � �0.:�
* 0 9 8 1 6 8 2 8 * `7'`�`'�`3
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
---� You must call the inspecfor when ready Dafe Ready:
1, �.licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: