P - 81063REQUEST FOR ELECTRICAL INSPECTION °�""'
0—V5C7-349 40 Minnesota State Board of Electricity
s 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -
(651) 642-0800 www.electricity.state.mn.us
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
NSP 3AVER'3 SWlTCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformeNGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriqation Boom
Fee - This Inspection Repuest will not be
0 to 200 Amps
Above 200 Amps
lNSPECTOR'S USE ONLY
In
i
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amos
TO�y�-
�O-Sv
Date
Speciallnspec �
Investigative ee F'"ei oaa� Z�_ a,
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THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I . . . . .. . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . .. . ... ... . . . . . .. . .. . .. . .. .. . . . . . . , .. .. . .. . .. . .. . .... . ... .. .. ... . . , .... m ......._....,..,.... n,.. R,.....,.,..,,........: .,,.'..,, *
OFFCE USE W�KY This request void 18 months fram validation date printed in this box.
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PLEASE PRINT OR TY —
R���� Rough-In inspection required? ❑ Yes � No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
You must call the inspector when ready! Date Reatly: �
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspect'wn of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY