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P - 81137�• • � • • • 1 • REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 __ _ (651) 642-0800 www.e/ectricity.stafe.mn.us Home Duplex Apt. Bldg. 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 request Enter remarks in this space and on the back of the white copy only. NSP 3AVER'S 3WITCH Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee. Mobile Home Park Stall Street Ltg. / Traffic Sig. Transformer/Generator Sign / Outline Ltg. Xfmr. Alarm/Remote Control Swimming Pool Irriaation Boom 0 to 200 Amps Above 200 Amps INSPECTOR'S USE ONLY I hereby certi(y that I inspected the electrical Rough In 0 to 100 Amps Above 100 Date apeciai mspe Investigative Fee F�ne� � Date . THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MONTHS. _._...._ _ ... ........................�.... .... OFFICE USE ONLY This request vdd 18 months from validation date printed in this box. IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�II/III� � �lJ � *08583098* 76� PLEASE PRINT OR TY Request Date Rough-In inspection required? O Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑�II Call � ���� You must call the inspector when ready! Date Ready: I, �J licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: �o-u�wiN-1G b/lyyy STATE BOARD CAPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY