P - 81173REQUEST FOR ELECTRICAL INSPECTION
��V'C75C7-315 50 Minnesota State Board of Electricity
1821 Universiry Avenue Suite 5-128, 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 the back of the white copy on/y.
N3P SAVER'3 SWITCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign J Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation BpQrq„ � _
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amo�
TO
�o. S"�
on the dates stated:
Investigative Fee ��� � / —" I D� 2-� �
THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTH
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OFFICE USE ONLY TINS request vdd 18 monfhs (rom validaGon dete printed in this box.
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*08583155* 76�
PLEASE PRINT OR TY
Re���� Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ��11 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