P - 82109�� REQUEST FOR ELECTRICAL INSPECTION ��E`'
'O 1 1-619 �2 Minnesota State Board of Electricity _
< 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ -
� (651) 642-0800 www.electricity.state.mn.us .
Jt 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" ahove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
NSP 3AVER'S SWITGH
Calcu/ate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
TransformedGenerator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. �•�
Alarm/Remote Control
� I hereb certi that I i ected tbe electrical installation described herein on the dates stated:
Irrigation B 'T, �„a, �„ oate
Special Inspection a�e
Investigative Fee F� �� �6 --E' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH 18 MONTHS.
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OFFICE USE ONLY This requeat void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ N� Inspection Other Than Rough-In: IJmeady Now � Will Call
�12�� You must call the inspector when readyl Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOlA-12 5/1999 STATE BOARD COPY Jtt IrvSI HuG i iurva vrv oiat,n vr T CLLVYY wr r