P - 81126E
REC�UEST FOR ELECTRICAL INSPECTION
��C�SC�-396 0 Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
. r {651) 642-0800 www.electriciry.state.mn.us
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy onty.
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Ca/culate lnsvection Fee - This lnsvection Reauest will not be accevted without the correct fee.
Mobile Home Park Stail 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign / Outline Ltg. Xfmr. ZD ��
Alarm/Remote Control
Swimming Pool
I hereb cert' 1F�at I inspected the electrical installation describetl herein on the dates stated:
Irrigation Boom Rou9h In Date
Special Inspecti
Investigative Fee _I � � � Q `�'�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
- - -._. •• -- _.._.. _... � �...�._ ...................... ........�... ..........,..........,..................,..........................
OFFICE USE ONLY This request voitl 18 months from validation date printed in this box.
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*08583965* 7�5
PLEASE PRINT OR E
qyest Date_ � Rou h-In ins tion
g pec required? � Yes No Inspection Other Than Rough-In: Ready Now � Will Call
�f-1 �� � You must call the inspector when reatlyl Date Ready:
I�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A•12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY