P - 81181REQUEST FOR ELECTRICAL INSPECTlON �`"�E
� �'C75�-337 [�9 Minnesota State Board of Electricity _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
� (651) 642-0800 www.electricity.state.mn.us .
Hame Duplex Apt. Bldg. Other: New Addn
Commercial Intlustrial 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. Ente� remarks in this space and on the back of the white copy only.
NSP SAVER'3 �WITCH
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
withoat the aorr•ect fee.
Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TC�y�p'�
,1I�
I herebvi certiv that 1 insnected the electrical installaUon described herein on ifie dates stated:
I I Investigative �ee v`'� v � rp�'� � ��� I��' C��
�� ��THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��^�m�«���:��������m OfFICE USE ONLY This request void 18 months from validation date printed in this box.
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*08583379* ���
PLEASE PRINT OR
Re���t Rough-In inspedion required? O Yes O No Inspection Other Than Rough-In: � Ready Now ��II 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-00001 A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY