P - 82193;1--011-449
� REQUEST FOR ELECTRICAL INSPECTION � E
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _ _
(651) 642-0800 www.e/ectricity.state.mn.us : ''
X 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.
Ca/cu/ate Inspection Fee - This
Installations Fee #
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
NSP SAVER'S SWITCH
will not be accepted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
# Circuits / Feeders F
0 to 100 Amps
Above 100 Amps
TOT� _r,
�B'�D
I hereb certi(y that I inspected the electrical i�stallation described herein on the dates stated:
Irrigation Bo � Rough In Date
Special Inspection
Investigative Fee Final D / ��
THIS,INSTALLATION MAY,BE ORDERED DISCONNECTED_IF_NOT COMPLETED W THIN 18 MONTHS.
�`L�� I IIIIII III I'I y ( OFFICE USE ONIY This request void 18 months from validation date printed in this box.
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* 7 0 1 1 4 4* � ���
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ IJ� Inspection Other Than Rough-In: L_YReady Now ❑ Will Call
�a 27��} 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