P - 82363-�'-015-819 4� REQUEST FOR ELECTRICAL INSPECTION ` F
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. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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 SAVEFrS SWITCN
Calcu/ate Inspection Fee - This Inspection Request will not be accepted without the conect fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
ZO.J�O
I hereby certify that I ins cted the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Speciallnspe �
Final Da -
Investigative Fee —Zd ��/
THIS INSTALLATION MAY BE ORDERED DISCONNEC7ED tF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII IIIII IIIII IIIII IIIII III �illll II� I�I OFFICE USE ONLY This request void 18 months from validallon date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-In ins ection re uaed? 0 Yes � NM Ins
g p q' pection Other Than Rough-In: Ready Now � Will Catl
� You must call the inspector when readyl Date Ready:
.
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
£B-00001A-12 5/1999' STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY