P - 82616RE T FOR ELECTRICAL INSPECTION ����
(� �,(� C, � � � /� � � Minn State Board of Electricity �'
�J , ��� `p 1821 niv sity Avenue Suite 5-128, Saint Paul, Minnesoia 55104-2993 =- .� �
. (65 642-0800 www.electricity.state.mn.us ��a�"
"X" above the work covered by this request. Enier remarks in this space and on the bock of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted wifhouf the correct fee:
Other Installations Fee # $ervice Enirance Size Fee # Circuits / Feeders Fee
Mobile Home Park $tall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr
Alarm/Remote Control
Swimminq Pool
0 to 200 Amps 0 to 100 Amps x�
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL �
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I hereb certi that I ins ecfed fhe elecirical insfallafion described herein on fhe dafes stated:
Rough-In Dafe
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Investigative Fee � �� �
THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S monihs from validation dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins ecfion re uired?
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g p q ❑ Yes � Inspection Other Than Rough-In:�}R,yady Now ❑ Will Call
� e�� �You must call fhe inspecfor when ready Dafe Reody:
I, �nsed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: