P - 81141REQUEST FOR ELECTRICAL INSPECTION
IO'�CJ8'3OC� � Minnesota State Board of Electricity F-
�✓ 1821 University AveAue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.elecfricity.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
7C" above the work covered by this request Enter rema�ks in this space and on the back of the white copy on/y.
Ca/cu/ate
Mobile Home Park Stall
Street Ltg. ! Traffic Sig.
Transformer/Generator
Sign ! Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
NSR BAVER'S 3WITCH
will not be accepted without the correct fee.
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TO�L,�,/�
V. .��
I hereby certify that I ins ed the electrical installation described herein on the dates stated:
Rough In Date
Investigative ee rmai �•��e �, I ua� ���� I
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_______.TNI$_�ST.ALLATION MAY.BE ORDERED DI NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE U8E �ILY This requeat void 18 montlis from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesi Date Rou -In ins
gh pection required? � Yes ❑ Inspection Other Than Rough-In: eady Naw � WiN CeN
� ���� You must caN the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-72 5/1999 STATE BOARD COPY SEE IMSTRUCTIONS ON BACK OF YELLOW COPY