P - 82163U�-�36-�60
REQ ST FOR ELECTRICAL INSPECTION
� Min ta State Board of Electricity �
1821 niversity Avenue Suite S-728, Saint Paul, Minnesota 55704-2993 ��`
(651 642-0800 www.electricity.state.mn.us "�_
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copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Insfallations Fee # Service Entrance Size fee # Circuih / Feeders Fee
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
Sign / Outline Ltg. Xfmr. �Ow •�
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ected fhe electrical installation described herein on the dates stafed:
Irrigation Bo Rough-In Dare
Special Insp
Final � . �o � ��_
Investigative Fee —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE U� ONLY This requast void 18 months from validafion date printed in fhis box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspection required2 ❑ Yes ,�Jo Inspecfion Ofher Than Rough-In: eady Now ❑ Will Call
5• ! 5•� You must call fhe inspecfor when ready Date Ready: �
1,�"ilicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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