P - 82394REQUEST FOR ELECTRICAL INSPECTION �—°
�� 019-810 � Minnesota State Board of Electricity �F:-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.elecfricity.sfate.mn.us
Home Duplex Apt. Bldg. Other: New Adtln
Commercial Industrial Farm Remod Repair
' ontliti 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 on/y.
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Ca/culate Inspection Fee - This Inspection Request will not be
�ther Installations Fee # Service Entrance Size Fee
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
TransformedGenerator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereby certify
Irrigation Boom Rough In
Special Inspecti
Investigative Fee F��
THIS INSTALLATION MAY BE ORDEREC
I(IIIII IIIII IIIII IIIII IIIII Illi �IIIII I� �) �.3y0FFlCE USE ONLY This request void 18 months from validation date printed in this box.
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*10198 9* `
� PLEASE PRINT OR TYPE
Request��� Rough-In inspection required? � Ye o Inspection Other Th � In ea�ow 0 Will Call
You must call the inspector when readyl Date Ready:
I, �Zensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amo:
TOTAL� �
that I inspected the electrical installation described herein on the dates stated:
Date
� --Z � 2.v-- o-�-
IF NOT COMPLETED WITHIN 18 MONTHS.
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK O�; YELLOW COPY