P - 82348REQUEST FOR ELECTRICAL INSPECTION � �° '
, 1-015-825 1[] Minnesota State Board of Electricity
F - i3
� 1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �'--_
(651) 642-0800 www.electriciry.state.mn.us
Home Duplex Apt. Bldg. Other: New Addn
Commercial Intlustrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by this request Enter remarks in tnis space and on tne nacK or rne wn�re copy on�y.
h1SP SAVEIiS SWITCH
Calcu/ate Inspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
AtarmlRemote Control
Swimmina Pool
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
1 hereby
Rough In
� � Investigative Fee � �
THIS INSTALLATION MAY BE 1
I IIIIII IIIII IIIII IIIII IIIII II I II�) IIII IIII
* 1 0 1 5 8 1*
without the crorrect fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
�.�
installaHon described herein on the dates stated:
Date
�,—�o- � � � „a� �6— O/ I
ED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-._ �._ _..�_ .......:.......... . . . .................. .......-.. . ....... .......
FFICE USE ONLY TMs requeat void 18 months from validation date printed in this box.
�Zo,.�o �-� s�
PLEASE PRINT OR TYPE
Request Date I Rough-In inspection required? ❑ Yes ❑ ND' Inspection Other Than Rough-In: LT Ready Now 0�II Call
_ w-,� 4. y��n You must call the inspector when ready! Date Ready:
r•r���. �+awi
I, [jdicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5(1999 STATE BOARD COPY � SEE WSTRUCTIONS ON BACK OF YEILOW COPY