P - 81076REQUEST FOR ELECTRICAL INSPECTION
,: fo—C75�-341 � Minnesota State Board of Electricity _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
'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 SWITCH
Mobile Home Park Stali
Street Ltg. / Traffic Sig.
Transfortner/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Fee - 1i�is
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
i
without the correct fee.
0 to 100 Amps
Above 100 _
TQ�
ao..sa
installation described herein on the dates stated:
Investigative , Fmei � ' � oat�� �y ,
THIS INSTALLATION MAY BE ORDERED DISC�NNECTED IF NOT COMPLETED WITHIN 18 MONT
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. . .............................._ ._._ _ - _- -- _._._ .
. OFFICE USE ONLY This req�at vad 18 months from validation date priMed in this box.
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*0858341 1 * (�� �
PLEASE PRINT OR TY
Regu���,Et�_ Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
7 Oy/i�tl You must call the inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at;
E&OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY