P - 82345♦'
�1-015-486 []2 REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _
(651) 642-0800 www.electriciry.state.mn.us
Home Duplex Apt. Bltlg. Other: New Addn
Commercial Industrial 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 Enter remarks in this space and on the back of the white copy on/y.
NSP SAVEFrS �WITCH
Calculate Inspection Fee - This lnsnection Reauest will 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
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TOTAL
ZD.JrO
I hereby certi that I inspected the electrical installation described herein on the dates stated:
Irrigation Boo �, m Date
Special Inspe
Investigative Fee Finai oat ,�1� _d
THIS INSTALLATION MAY BE ORDERED DISCO D IF NOT COMPLETED WITHIN 1�_MONTHS __.
................. .............................._ -._..,....,...................�.....
^v 1155CE USE ONLY This request vad 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ o Inspection Other Than Rough-In: Ready Now O�II Call
���►� You must call the inspector when ready! Date Ready:
I, [�Oicensed 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 CAPY