P - 81064E
REQUEST FOR ELECTRICAL INSPECTION
� �°Q5Q_Q47 � Minnesota State Board of Electricity
v v v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us
Home Duplex Apt. Bltlg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request Enter remarks in this space and on tne back ot tne wrnte copy onry.
N3P SAVER'S SWITCH
Calcu/ate Insvection Fee - This Inspection Request will not
Mobile Home Park Stall
- Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
.S�
I hereb certiy that I inspected the electrical installation described herein on the dates stated:
Irrigation Boor� `^� -� p� In Date
Special Inspec io
Flna� ��'Z . 2o—c9 �%
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.._.. __. ......._ ....... ....... ..... ._ .._..._..._.__. ................................................�.�......�...,...........t. . .
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii�iiiiiiiiii ,, ao��
*08583478*' �3�
PLEASE PRINT OR TY
Re u st D t Rough-In inspection required? ❑ Yes � No Inspection Other Than Rough-In; � Ready Now ❑ Will Call
��/1� You must call the inspeaor when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001 A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS OIV BACK OF YELLOW COPY