P - 80223REQUEST FOR ELECTRICAL INSPECTION �
(� o� p p���� � Minnesota State Board of Electricity `�
lJ (? � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us `'�'
copy only.
Calculpte Inspection Fee - This Inspection Request will nof be accepted withouf the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders FE
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 TO
Sign / Outline Ltg. Xfmr. �
Alarra/Remote Control
Swimming Pool
I hereb certi that I irys cted the electrical installation described herein on the dates stated:
Irriqation Boom Ro��nh-In Da�e
Investigative Fe • r� (�� ��Gi �E.�.-`„� I�j� ��i Qv I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monlhs (rom validation date printed in this box. �
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PLEASE PRINT R TYPE
Re esf Dafe � - Rough-in inspecfion required8 - s� No Inspection Other Than Rough-In: Ready Now � Will Call
� — You must call the inspecfo� whe rea Dafe Ready:
I,{ L�Q licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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rob Address (Street, Box, or Route No.) . n_ Cityr„ . Zi�Code
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Phone
�m an or Owner Performin Insfa tion Phone Number
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STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY