P - 82507��"OGO-412 1� REQUEST FOR ELECTRICAL INSPECTION �-E
Minnesota State Board of Electricity _ 3
� 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us . `
X Home Duplex Apt. Bldg. 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 only.
NSP SA1{ER'S SWRCH
Ca/cu/ate lnspecti�
Jther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformerlGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPEGTOR'S USE ONLY
- I hereby certity that I
Irrigation Boom Rougn in
Special Insp
Investigative Fee Final
THIS INSTALLATION MAY BE ORDERED DI
.. . ................. . ..................... . .. ........OFFICE
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I IIII�I IIIII I�III II�N I�III II I�I ��I 1�1
the
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOT�AL�
�n described herein on the dab
Date
' °& ���.—O'�
SCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
...........................���,._.�_z�•_�_�..,.,..�.:,�.� P �.,................,.......
USE 0lILY TMs request vad 18 months from validation date rinted in this box.
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��%' �v PLEASE PRINT OR E
Request Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ 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-0OOO1A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY