P - 82340�-���9��639 �l
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REQUEST FOR ELECTRICAL INSPECTION °'E
Minnesota State Board of Electricity 3
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 i�;
(651) 642-OS00 www.electricity.state.mn.us `'�'
Furnac�e_
Calculate Inspection Fee - This Inspection Request will not be accepted wiihout the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / TraFfic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT^A/L�
Sign / Outline Ltg. Xfmr. �j,6� OCV ��
Alorm/Remote Control � I!'O{
POOI
that l insoected the electrical installation described herein on the dates stated:
I � Investigative Fee ' �" � �/a'f9^�} �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 mon m validation date prinfed in this box.
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* 0 9 9 6 6 3 9 1* ���
PLEASE PFfINT OR TYPE
� R uesf Dafe Rough-in inspection required? ❑ Yes ❑ No Inspection Ofher Than Rough-In: �Ready Now ❑ Will Call
�'� �a—� You must call the inspector when ready Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: