P - 82346�� _O♦ �_wH-7 � REQUEST FOR ELECTRICAL INSPECTION E
�
i t r Minnesota State Board of Electricity '�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us '�° '
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 tne back ot tne wn�te copy onry.
NSP SAYEFrS SWITCFi
Calcu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Inctallations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer(Generator
SignJ Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps 0 to 100 Ai
Above 200 Amps Above 100
INSPECTOR'S USE ONLY
•
.1 �1
I hereby certity that I ins ected the electrical installatlon described herein on the dates stated:
Irrigation Boo �- �, Rou9n in Date
Special Insp
Investigative Fee �� D "'��
THIS INSTALLATION MAY BE ORDERED DI CTED IF NOT COMPLETED WITHIN 18 MONTHS.
...,..,..,.,,, v. s.u,.,.-..,. _..v.�.y.y.1.�.,� -._ ........................................... . ................... . . ................................................ .
I I�IIII �I�II �II�) I1III �IIII I� II�I IIII ��� ^ OFFlCE USE ONL� requeat void 18 maNhs from validation date printed in this box.
I
�, � �� �
*10154 0*
PLEASE PRINT OR E
Reque t D�atet ��y� Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: � Ready Now ��II Call
��� G I �l.W V You must call the inspector when readyl Date Ready:
I, [�icensed 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