P - 80791REQUEST FOR ELECTRICAL INSPECTION
p_�CJ4_(�48 � Minnesota State Board of Electriciry -_
V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
� (651) 642-0800 www.electricity.state.mn.us : • `'
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 on/y.
NSP SAVER'S SWITCH INSTALlAT10PV
Ca/cu/ate Inspection Fee - This Inspection Request will not be
'nstallations Fee # Service Entrance Size Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amp.
TOTAL .
I hereb certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
i� Special Inspection • [�
Investigative Fee F�� fze— `� —6 7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
����Mww� ��Ww4y.�WW�.�.Y�„.��W�.~ M����OFFICE USE ONLY This request void 18 months from validatlon date printed in this box.
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Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than RougF�n: � Ready Now ❑ Will Call
� j,17�� You must call the inspector when ready� Date Ready: � ��.�,� �_
I, [�Qicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001 A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY