P - 825711��U 14-553 0
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REQUEST FOR ELECTRICAL INSPECTION e°
Minnesota State Board of Electricity '� �
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182 1 University Avenue Suite S- 1 2 8, Sain t Pau l, Minneso ta 5 5 1 0 4- 2 9 9 3 =__ ._�
(651) 642-0800 www.electriciry.state.mn.us :�LL�
� Home Duplex Apt. Bldg. 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 the back of the white copy only.
NSP SAVER'8 �WITCH
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct ee.
nsTallations Fee # Servir.e EnTranr.e Size Fee # Circuits / Feeders Fee
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 TOTAL
Sign./ Outline Ltg. Xfmr. �•�
Alarm/Remote Control
Swimming Pool
I hereby certiy that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
Final D � i �0.
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DIS ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY �This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date „ b
Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: LJ Ready Now ❑ Will Call
'1,.��' 0� �,f�0 You must call ihe inspector when ready! Date Ready:
I, [�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY