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.
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*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