P - 80287, p-855-741
❑ REQUEST FOR ELECTRICAL iNSPECTION
5 Mi�nesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us . '
Home Duplex Apt. Bidg. Other: New Atldn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. oad 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 BWITCH INSTALLA710N
a�3 �:�:5 S�;-�e.�
Calcu/ate Inspection Fee - This Inspection Request will not be accepted without the correct ee.
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Cpntrol
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
�.
installaGon described herein on the
""y°""" """"' - - Rough In oaie
S ciallnspection �
Rnal Dat p� Q O
Investigative Fee "l
THIS INSTALLATION MAY BE ORDERED D NNECTED IP NOT COMPLETED WITHIPI 18 MONTHS.
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OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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*08557415* ���
PLEASE PRINT OR TYPE
Request Date Rou h-In ins ection � nspection Other Than Rough-In: �61 Ready Now ❑�II Call
,�.��g g p required?�Yes No I
You must call the inspector when ready! Date Ready:
I, ❑ I�ensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY