P - 81060�. � 0-858-342
❑ REQUEST FOR ELECTRICAL INSPECTION
9 Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.elecfricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Addn
Commercial Intlustriai 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 SAVER'S SWITGH
Calcu/ate Inspectic
Jther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
- This Inspection Request will not be accepted without the crorrect fee.
0 to 200 Amps 0 to 100 Ai
Above 200 Amps Above 100
INSPECTOR'S USE ONLY
Irri ation Boom I hereby certify that I inspected the electrical installation described herein on the dates stated:
g Rough In Date
Speciallnsp n
Flnal Dat
Investigative Fee , 2 : j "a �
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 Mc�t�u_
:-..�.....-....._.�.�_"'-'°------------��----�-- --- - - . - . P.._
OFFICE USE ONLY This requeef void 18 rrionths tfom valtdation clate rinted in Mis box.
I IIIIII IIIII �IIII IIII) III�I IIIII��I IIII III) � �-�
*08583429* ��
PLEASE PRINT OH TY
R���� Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � W��I Call
You must call the inspector when readyl Date Ready:
I, 0 licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Eg-0p001A-12 5/1999 STATE BOARD COPY SEE INSTRUC i iurvs urv nA�n vr , ����... ....� �