P - 823641•-0 � 5-szo 0 REQUEST FOR ELECTRICAL INSPEGTION
Minnesota State Board of Electricity '�
f 1821 University Avenue Suite 5-128, 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 Contlitioner 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.
IV�P SAYER'S SWITGN
Calcu/ate Inspecti�
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
1'rrigation Boom.--, �.. _
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certity that 1 inspected the electrical
Rough In
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
�.�
Date
I I �nvestigative Fee I I / I !`""77' �-G 1 I
THIS INSTALLATION MAY 8E ORDERED DI ECTED IF NOT COAAPLETED WITHIN 18 MONTHS.
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ss I�II`II II fI` �III� IIII` lll`� (II`^� ylll) I`II �I ofFlCE use orKr nns reques� vad � a monme trom vaiida�ion da+e primed in mis tox.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ Ne Inspection Other Than Rough-In: C7 Ready Now � Will Call
You must call the inspector when readyl Date Ready:
I, [j4icensed 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