P - 81148, (J- �$-296 07
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricrty.state.mn.us : '�
Home Dupiex Apt. Bldg. Other: New Addn
Commercial Industrial farm Remotl Repair
Air Conditioner Htg. Equip. Water Htr. Loatl 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 whife copy only.
N3P SAVER'3 SWITCH
Calculate lrtsqection Fee - This Insnection Reauest will not be acceated without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTiq��- '�j�
�,vs��r�� 'Ln. S V
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I herebvi certifv that I insoecfed the electrical installation described herein on the dates stated:
Special Inspe�or�
Investigative Fee � � °a� o Q
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
� OFFICE USE ONLY This request voitl 18 months hom validatian date printed in this box.
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*08582967* 76�
PLEASE PRINT OR TY
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Otlier Than Rough-In: Ready Now O Will Call
������ You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at;
EB-0OOO1A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY