P - 81240REQUEST FOR ELECTRICAL INSPECTION
U����- 4 5 7� Minnesota State Board of Electricity
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 ���.
� (651) 642-0800 www.electricity.state.mn.us 'm�`
"X" above the work
Calculate Inspection Fee - This Inspection Requesi will not be accep►ed without the correcf fee:
illations Fee # Service Enhance Size Fee # Circuits / Feeders
Mobile Home Park Stall
Street Ltg. / Traific Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Co�trol
Swimming Pool
Irriqation Boom
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TO�TpjJ,_
that
t
� ao. s�
described herein on thl� dates stated:
Finol f 4iL_ 0� �—�'%`'C%C
Investigative Fee ( /'�' _
THIS INSTALLATION MAY BE ORDERED DI NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S months from validation date printed in this box.
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PLEASE PRINT OR TYPE
R uest Dafe Rough-in inspecfion required? ❑ Yes o Inspecfion O�er Th n Rou h-In: eady Now ❑ Will Call
(� � 5'� q' � You must call the inspector when ready Date Ready: �`�— �
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'�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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