P - 81132REQUEST FOR ELECTRICAL INSPECTION ���
�-� 6 6� 4� O � Minnesota State Board of Electricity �� 3�
1821 University Avenue Suite 5-128, Saint Paul, Minnesoia 55104-2993 -
` (651) 642-0800 www.electricity.state.mn.us "�`''�
Calculate fnspeciion Fee - This lnspecfion Request wi!! nof be accepted without tf�e correct fee:
Other Installations Fee # Service Enhance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline ltg. Xfmr. ��. �
Swimming Pool
_� rr �. .tic. I herebvi certifv ihof I inscecfed ihe electrical installation
Dafe
Investigative Fee r��a� � 1 � I�O�%�" �JI
THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesh void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes o Inspection Ofher Tha� Rough-In: ady Now � Will Call
� You musf call fhe inspector when ready Dare Ready: , �
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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