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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 Inspe
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Tra nsformer/Generator
Sign / Outline Ltg. Xfmr.
AVarm/Remote Conhol
Swimminq Pool
Clce�sc� C�f� �7�7-7g�5
tion Fee - This Inspection Request will not be accepted without the correct fee:
Fee # Service Entrance Size Fee # Circuifs / Feeders Fee
0 to 200 Amps �0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOSAL
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� Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED
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fhe elechical installotion described herein on the da
Dafe
DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS:
OFPICE USE ONLY This request void 18 months kom validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes �JJo Inspecfion Other Than Rough-In: ❑ Ready Now�jvVill Call
��`� I You must coll the inspector when ready � Dafe Ready: �
1, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: