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REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity �'
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =
(651) 642-0800 www.electricity.state.mn.us "�'
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correci fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Trans(nrmer/Generator INSPECTOR'S USE ONLY TOTAL.
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the elechical installaHon described herein on the dates stafed:
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Final
Investigative Fee r-f �j ^ �
THiS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI IN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validafion dofe prinfed in this box.
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� PLEASE PRINT OR TYPE
Rough-in inspection required$ ❑ Yes Inspection Other Than Rough-In: ❑ Ready Now � Will Call
� You musf call the inspecror when reody Dafe Ready: ��.
contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: