P - 81178, REQUEST FOR ELECTRICAL INSPECTION
O—Ca5�-334 � Minnesota State Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.sfate.mn.us ': '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industriai 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,
N3P SAVER'S SWITCH
Ca/cu/ate lnspection Fee - This Inspection Reauest will not be accented without the co�rect fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
AlarmlRemote Controf
Swimminq Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
tnat
0 to 100 Ai
Above 100
Date
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� � Investigative Fee � � r� ��' ��� ��!'/ �
THIS INSTALLATION MAY BE ORDERED DISCONNECrED IF NOT CONIPLETED WITHIN 18 MONTHS.
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OFFICE 1lSE ONLY TFds tequeM wid 18 mondis from validallon date printed in this box.
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PLEASE PRINT OR
Re�y�� Rough-In inspection required? � Yes ❑ No Inspedion Other Than Rouglrin: � Ready Now � Wili Cali
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You must call the inspector when ready! 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