P - 81147' REQUEST FOR ELECTRICAL INSPECTION E
, O'C7�$-297 � Minnesota State Board of Electricity
, 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _
(651) 642-0800 www.elecfriciry.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 and on the back of the white copy only.
NSP SAVER'S 3WITCH
Ca/culate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Fee - This Inspection Request will not
:e # Service Entrance Size Fi
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
the correct
0 to 100 Amps
Above 100 Amps
TOTw�lrn..•
�L7�rR� '�
1 hereby ce ' that I inspected the electrical installation describetl herein on the dates stated:
Irrigation Boom Rough In Date
Special insp r`� *-
Investigative e "� � oatg��_��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED tF NOT COMPLETED WITHIN 18 MONTIiS.
��W��Y � W K�,�w�w� W� M_.0 ..�.� w��+OFfICE USE ONLY This request vad 18 months from validation date printed in this box��m
� II�11� �fl� I�I�I IIi�� IiI�� III���I �tl �II � �D `�
*08582975*
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PLEASE PRINT OR TY
Request Date Rough-In inspection required? 0 Yes ❑ No Inspection Other Than Rough-In: Ready Now O Will Call
� ���� You must call the inspector when ready! Date Reatly:
I, �J licensed contractor ❑ company ❑ owner hereby request inspection of the above electrica! work at:
EB-OOOOtA-12 5/1999 STATE BpARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY