P - 81179�`
� �-858-335 �3
REQUEST FOR ELECTRICAL INSPECTION �"' E`'
Minnesota State Board of Electricity --
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -_ _
(651) 642-0800 www.electricity.state.mn.us
'X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
N3P SAVER'S SWlTCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformeNGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Bodo% t°; ;" �
- This lnsvection Reauest will not be accented without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certify that 1 inspected the
Rouqh In
0 to 100 Amps
Above 100 Amps
TO
-Sd
installation described herein on ttie dates stated:
oate
investigative Fee F� ��i,.,it----�--- I U�j�� �'m I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT CO N 18 MONTHS.
�..w....». ,.. ,....... ... .
QFFICE USE ONLY This request void 18 months from vaAdation date printed in this box.
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*08583353* 765�
PLEASE PRINT OR TY
R�� Rough-In fnspection required? � Yes � No Inspection O[her Than Rough-In: � Ready Now � Will Call
You must call the inspector when reatlyl Daie 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