P - 81175' ,. REQUEST FOR ELECTRICAL INSPECTION
0'C.aSC)-330 �4 Minnesota State Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
• (651) 642-0800 www.e/ectricity.stafe.mn.us r '
Home Duplex Apt. Bldg. 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 SAVER'S 3W{TCH
Ca/culate Inspecti�
Other Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
Fee - This Inspection Request will not be accepted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
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0 to 100 Amps
Above 100 Amps
TO.�eQ'
. �-y�
,v
n described herein on the dates stated:
Date
Special Inspectfllh � J ( `
Investigative Fee Fin� �Qy oete� , �
3
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFRCE USE ONLY Thia requ�t vdd 18 months trom validation date printed in ihis box.
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*08583304* 76�
PLEASE PRINT OR
Re��t Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: � Ready Now ❑ WNI Call
You must call the inspector when readyl Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY