P - 82508� ,
�020-494 � REQUEST FOR ELECTRICAL INSPECTION E
Minnesota 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. Bltlg. 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. Enfer remarks in this space and on me pacrc or me wnrre copy onry.
NSP SAVER'S SWITCH
Calcu/ate Inspection Fee - This Inspection Request will not be accepied 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
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certity that 1
Rough In
0 to 100 Amps
Above 100 Amps
TOTAL
� 50
n described herein on the dates
Investigative Fee F��I ` � �� c I D�j1 L"� � I
THIS INSTALLATION MAY BE ORDERED DISCONNE OT COMPL MONTHS:
........................,...............,......,...._._ ,. ,..,.....,,..._._._.__._�:�•.,.•�,.:�.•�L.T_.�E.lA...'....�'�^...J.u....,..........._................... .... .. .
� OFRCE USE ONLY This request void 18 months from validation date printed in ffiis box.
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����� PLEASE PRINT OR TYPE
Request Date Rough-In inspection requiretl? ❑ Yes ❑ No Inspection Other Than Rough-In: Reatly Now ❑ Will Call
�,�y�„ 2%� LWV You must call the inspecior whert ready! Date Ready:
I, [�Vicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOD1A-12 5/1999 STATE BOARD COPY � SEE lNSTRUCTIONS OM BACK OF YELLOW COPY