P - 82368�'O ��'pn -1 � REQUEST FOR ELECTRICAL INSPECTION E
� ��G � Minnesota State Board of Electricity N:-
. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _ -
(651) 642-0800 www.elecfricity.state.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 antl on tne bacK oi tne wnite copy onry.
NSP SAYER'S SWITCH
Calcu/ate Inspecti
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign ! Outline Ltg. Xfmr
Alarm/Remote Control
Swimming Pool
II'�I48tlOf1 BOOfiI
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby
Rough In
�ted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amp;
TOTAL
�.�
described herein on the
Date
Investigative Fee � � �� — �8�e� "Z,!' 6� �
THIS INSTALLATION MAY BE ORDERED D CONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 48 moMhs from validaUon date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ Nd` Inspection Other Than Rough-In: C?Ready Now � Will Call
You must call the inspector when readyl Date Ready:
I, [jdicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY