P - 81180i' REQUEST FOR ELEGTRICAL INSPECTION " E'
.�'C�58-336 1[] Minnesota State Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us ''.� '
Home Duplex Apt. Bldg. Other: New Addn
Commerciat Industr+al Farm Remod Repair
Air Conditioner Ntg. 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 tAe back of the white copy only.
N3P 3AVER'3 3WITCH
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmino Pool
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 _
INSPECTOR'S USE ONLY l
I herebvi certiN that 1
v'�
on the dates stated:
Investigative Fee F� � I�� I��'���
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
������Xw������'w�~�.�M�„�~YOFfICE USE ONIY This requeat void 18 months from validation date printed in this box.
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*0858336� * 76J�
PLEASE PRINT OR TY
Req�{gSt.p�ip„� Rough-In inspection required? � Yes � No Inspection Other Than Rough-In: � Ready Now 0 Will Call
r �t�tiy�rR�
You must call the inspedor when readyl Date Ready:
I, ❑ licensed 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