P - 82290w� REQUEST FOR ELECTRICAL INSPECTION ����
U`° g�/� -[/� � � Minnesota� tate Board of Electricity
�a• �a �} 1821 Universi Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us ���'
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copy only.
Calculate Inspec►ion Fee - This Inspection Reques► will not be accepfed without the correct fee:
Other Installations Fee # Service Enhance Size Fee # Circuifs / Feeders Ff
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT^AL
Sign / Outline Ltg. Xfmr. d��
Alarm/Remote Control
Swimming Pool
I here certi that I ins cred the elechical insmllation described herein on the dates stafed:
Irriqation Boom �� `�� R�v�nitlo Date
� Investigative Fee � � ( � �� `�7–'�'�rV
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Raqvesf Date Rou h�-in ins ection re uired?
�' �� g p q ❑ Yes �Jo Inspeclion Ofher Than Rough-In: ❑ Ready Now�Will Call
You must call fhe inspecror when ready Date Ready:
I,'�llicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: