P - 826321-0 �5-270 0
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REQUEST FOR ELECTRICAL INSPECTION E
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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.
Calculate Inspection Fee - This
ncTallaTinnc Fee #
(V�P �AVER'� �WITCH
will not be
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify tl
Irrigation Boo Rough In
Special Inspe
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED
................... -....-.._. -..........-...--.-. -._.—..� _.... .... —.,.._-..-. -x
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I IIIIII IIIII IIIII IIIII IIIII III
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the
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
� TOTAL
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installation described herein on the
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�ISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.. . .................................... . .................................. P .............................
USE ONLY This request void 18 months from validation date rinted in this box.
Request Date I Rough-In inspection required? ❑ Yes 0 �
�, ,�„ a,� .yyy� You must call the inspector when ready!
, a D. 5d
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PLEASE PRINT OR TYPE
Inspection Other Than Rough-In: Ready Now ❑ Will Call
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 c�rv tfa�n vr TCLLVVV wr,