P - 80348� REQUEST F�R ELECTRICAL INSPECTION �
L.i �`� O C� - 3 4 3 � Minnesota State Board of Electricity 3=
. 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.eleciricity.state.mn.us "�'
copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted withoui ihe correct fee:
Ofher Installations Fee # Service Enirance Size Fee # Circuits / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traific Sig. Above 200 Amps Above 100 Amps
Tra�sFormer/Generator INSPECTOR'S USE ONLY TOT
Sign / Outline Ltg. Xfmr. I
Alarm/Remote Control
Swimmin Pool
1 hereb certi that I ins ected the elechical installation described herein on the dates stal
Irriqation Bqp[TI� _ _ Rouoh-In Date
- Final / l I D�j •Z C �.� I
Investigative Fee L ! "
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion dafe prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Dak Rough-in inspecfion required� ❑ Yes o Inspection Other Than RougMn: eady Now 0 Will Coll
�'- ���� You must call fhe inspector when ready Dafe Ready:
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above e{ectrical work at: