P - 82505E
1/�2Q_41 Q � REQUEST FOR ELECTRICAL INSPECTION —
'C� Minnesota State Board of Electricity
, 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 =_ ,
f (651) 642-0800 www.e%ctricity.state.mn.us
X Home Duplex Apt. Bldg. Other: New Atldn
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 on/y.
NSP �4VER'S SWITCH
Ca/culate lnspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig,
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control.
Swimmina Pool
- This lnsvection Reaues� wil/ not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiN that I
without the correct fee.
;,ircuits ! Feeders
0 to 100 Amps
Above 100 Amps
TO��
installation described herein on the dates stated:
irnganon tsoo + Rough In Date
Special Inspection
Final Dat � �� O�
Investigative Fee
HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N07 COMPLETED WITHIN 18 MONTH:
. .. .....,....,,,..,..,..,._.,..ri�.•�•�•�,..•vy,�,.,......_.... -.�..r�-.�..,�.,..,...,�. . . . . . . . . . .
� i��� �I�II II��I �j��I �I� I�I� `II� OFFICE USE ONLY This�'tkquest vad 18 moMhs (rom validation dafe printed in this box.
I� I I
. i
*yo2oa.y �* �:#�����
vZO• S V PLEASE PRINT OR E
Request Date Rou h-In ins ection re wred? ❑ Yes � No Ins ectian Other Than
g p q' p Rough-In: O Ready Now � 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-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY