P - 82211� 1'O 1�-442 �9 REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity
ti 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 - _
(651) 642-0800 www.e/ectricity.state.mn.us
x 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 on/y.
NSP SAVER'� SWtTCH
Calculate Inspection Fee - This Insvection Reauest 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
II'I'148t1Of1 �BOO�PI � /
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
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I herebv certiN that I insoected the electrical installation described herein on Uie dates stated:
Investigative Fee � ` I��o' 3r- � a I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-- ----_------.._�__.___._.,.,._---_____--_-_-_-• .....................��� USE ONLY �This request vdd�18 months from validation date Printed in this box...........
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' PLEASE PRINT OR TYPE
Request Date Rough-In inspection required7 ❑ Yes ❑ NO� Inspection Other Than Rough-In: LJTeady Now � Will Call
(����� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
t�s-00007n-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY