P - 82631REQUEST FOR ELECTRICAL INSPECTION —E
,1-015-269 02 Minnesota State Board of Electricity HF- �,
. 1821 Universily Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 �'�������
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� (651) 642-0800 www.electricity.state.mn.us :��:
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Home Duplex Apt. Bltlg. Other: New Addn
Commercial Intlustrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Neat Temp. Service
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
N�P SAVER'� SWITCH
Calculate Inspection Fee - This Inspection Request will not be
i.,�.�u���.,..� Foc it Geroir.a FnTranr,e Size Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Gene rator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
�ircuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL
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I hereby certify that I inspected the electrical installation described herein on the dates state :
Irrigation Boo Rough In Date
Special Inspection
Fina� ��._ —2�—oC�
, Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I UFFICE llSE ONLY This request void 18 months from validation date rmted in this box. �
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes ❑ Nb' Inspection Other Than Rough-In: C7 Ready Now ❑ Will Call
�..�. � i rsrw� You must call the inspector when ready! Date Ready:
I, [�Qicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK VF vt�ww wrr