P - 82499REQUEST FOR ELECTRICAL INSPECTION �
U � � � � - � � ^ � Minnesota State Board of Electricity �
L} 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ���
� (651) 642-0800 www.electricity.state.mn.us 'm�'
"X" above the work covered by this request. Enier rei
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Calculate
Mobile Home Park Stall
STreet Llg. / Traffic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
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Fion Fee - This Inspection Request will no► be accepted wi►hout the correci fee:
Fee # Service Enhance Size Fee # Circuits / Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL� /�
the electrical installafion described herein on the da
Date
' Final � ' ���c � Uare �,Z.���'
Investigative Fee �--1 r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
' ^ OFFICE USE ONLY This request void 18 months 6om validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE
�pu st Dpte Rough-in inspection required? ❑ Yes lo_ Inspection Ofher Than R ugh-In: ead Now ❑ Will Call
'���-� You must call the inspector when ready Dare Ready: / f �
I, �Qiaensed contractor ❑ company ❑ owner hereby request inspection of the above e�ectrical work at: