P - 82572��-014-554 �8 REQUEST FOR ELECTRICAL INSPECTION �v��„ ,
Minnesota State Board of Electricity �F:- _ _�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 .
(651) 642-0800 www.electricity.state.mn.us :,�
:: Home Duplex Apt. Bltlg. Other: New Adtln
Commercial Intlustrial 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.
Calculate Inspection Fee - This
nstallations Fee #
N�P SAVER'S �WITCH
will not be
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without the correct 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 TOTLa�
Sign / Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Speciai Inspection
Investigative Fee Finai � oa� ��
THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. --
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I IIIIII IIIII IIIII IIIII IIIII IIII IIII IIII IIII OFFICE USE ONLY This request void 78 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date I Rough-In inspection required? ❑ Yes 0 No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
,�u(j� ���Q You must call the inspector when ready! 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