P - 82208. �-011-444 05
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REQUEST FOR ELECTRICAL INSPECTION �' E�
Minnesota State Board of Electricity ti� °�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us
X Home Duplex Apt. Bidg. 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 on/y.
Ca/culate Inspecti<
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Atarm/Remote Control
Swimming Pool
Irrigation Boom
N3P SAVER'S SWITCH
Fee - This Inspection Request will not be accepted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
0 to 100 Amps
Above 100 Amps
TOTAL
��o?D. S?�
on the dates stated:
Investigative Fee � < �� I��-2 Z,—ci / I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
:._.... � : ................................4 ..............�,.................. ....... .... . ... .................................... . . .. ............. .... . .. .... .......... ............
I IIIIII IIIII Iilll IIIII IIIII II I�N NII IN� � UEE ONLY This roquest vad 18 months from validation date printed in this box.
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' * 1 0 1 1 4 5* c3S�J�
PLEASE PRINT OR TYPE
Request Date Rough-In inspec[ion required? ❑ Yes � N� Inspection Other Than Rough-In: I�Ready Now ❑ Will Call
�2��� 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-72 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY