P - 823441r 015-824 � REQUEST FOR ELECTRICAL INSPECTION
�
Minnesota State Board of Electricity ��
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ _
(651) 642-0800 www.e/ectricity.state.mn.us : `'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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 SAYER'S SWITCH
Ca/culate Inspection Fee - This Inspection Request wil/ not be accevted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
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In
0 to 100 Ai
Above 100
TOTAL
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described herein on the dates stated:
apec�ai mspe
Investigative Fee �d � Final Date � 2�_� �
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I(IIIII I�II IIIII IIIII IIIII II II�I ��I OFFICE USE ONLY This requeat vad 18 months rom validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes ❑ N� Inspection OQier Than Rough-In: �Ready Now ❑�II Call
�_� �� You must call the inspector when ready! Date Ready:
I, [�(icensed 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