P - 81157. 0-�58-313 �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity -
182i University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 _ -
(651) 642-0800 www.electricity.state.mn.us r
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
N3P 3AVER'S 3WITCH
Calculate Inspecti�
�therFnstallations
Mobite Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
IrrigaHon Boom
- This Inspection Request will not be
0 to 200 Amps
Above 200 - Amps
INSPECTOR'S USE ONLY
Rough In
wlthout the correct iee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
that I inspected the electrical installation described herein on the dates stated:
� � Investigative Fee � � f � ��3 )— �/ �
.. _. ... .,THIS INSTALLATION MAY BE ORDERED DISC6NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 1 B months from validation date printed in this box.
I ��I�I� I�II� I�III �I�I) �II�1 III�IIII � � � �O � �
*08583130* ��J`�i
PLEASE PRlNT OR TY
Regu,g��D�t�_ Rough-In inspection required? � Yes � No Inspection Other Than Rough-In: � Ready Now ��II Catl
� 9 ����, You must call the inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
etc-vulU7q-72 5/1998 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY