P - 80799F
. REQUEST FOR ELECTRICAL INSPECTION
O_8CJ,4,_6'q,0 � Minnesota State Board of Electricity -
r 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -_ _
(651) 642-0800 www.e/ectricity.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 only.
n� sAVE�s swrrcH in�sra.u��av
Ca/cu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. 1 Traffic Sig.
TransformedGenerator
Siqn / Outline Lta. Xfmr.
Boom
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby certify that I inspected the
Rough 1�
0 to 100 Amps
Above 100 Amps
TOTAL �
installation described herein on the
Date
� � Irnestigative Fee � � C � joC-L� C�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH
._ _�_..•,��u�� ...�_�1. � s a•..,�,. .. .. y.. .. .. ,.. . . ...
.�... . .. ....... ..... . . . . ..u_....�.....W,.......,..,.......,� ..,........_..........,... .........,.......W.�.�...W.u.�...._..
OFFICE USE ONLY This request void 18 montlis trom validation date printed in this box.
������� ����� (���� ����� ���� ����� ���� ��� � ao .�
*08546400* �7g9
Request Date I Rough-In inspection required? � Yes � fi�p I Inspection Other Than Rougt,yr. ❑ Ready Now ❑ Will Call
� f,�,��yy You must call the inspector when ready�� Date Ready: A __ _,_ ��
I, [jQicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: