P - 81174r0-858-314
REQUEST FOR ELECTRICAL INSPECTION °�'' ° �
� Minnesota State Board of Electricity
1821 University Avenue Suite 5-126, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
'X" above the work covered by this request. Enter remarks in this space and on the back of the whife copy only.
N3P 3AVER'S 3WITGH
Ca/cu/ate
Mobile Home Park Stall
Street Ltg. f Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
AlarmiRemote Control
Swimmina Pool
Fee -
wiii not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
In
without the
0 to 100 Amps
Above 100 Amps
-ro�D, S o
Date
9 —- Finel / f� I Dat�_ 2�D'_ pd I
Investi ative Fee �
THiS INSTALLATION MAY BE ORDEREO NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFflCE USE ONLY TYua requeat vad 18 months from validation date printed in this box.
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*085$3148* ���
PLEASE PRINT OR TY
RB���� Rough-In inspection required? � Yes 0 No Inspection Other Than Rough-In: 0 Ready Now 0 Will Call
You must call the inspector when ready! Date 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