P - 81138' REQUEST FOR ELECTRICAL INSPECTION E
,,J'858'QOQ � Minnesota State Board of Electricity _
�+ V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.sfate.mn.us
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial 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 repuest Enter remarks in this space and on the 6ack of the white copy only.
Ca/cu/ate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Fee -
N3P 3AVER'3 SWITCH
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
0 to 100 Amps
Above 100 Amps
Irrigation Boo I hereby certify that I inspected the electrical installatlon described herein on the dates stated:
Rough In Date
Speciallnsp o� `
Investigative Fee Final �a _� ' o�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
~.MY.,.�.~.�.-M_��..����,~.~���„��,T OPFICE USE ONLY This request void 18 months from validation date printed in this box.
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Request Date Rou h-In ins ection
g p required? ❑ Yes ❑ o Inspection O[her Than Rough-In: eady Now ❑ Will Call
71/19/8� 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