P - 82349I
,1 '� 1 5-4HH � REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity _
1821 University Avenue Suite S-12$ 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 on/y.
hlSP �AVER'S SVYITCH
Ca/culate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltq. Xfmr.
Alarm/Remote Control
Swimmina Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
0 to 100 Amps
Above 100 Amps
TQZQI�
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Speciallnsp `
Investigative Fee Fi�� �--Z. i�– o"*—
. THIS INSTALLATION MAY BE ORDEREDsDISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII IIIII IIIII IIIII IIIII II (IIII I� I�I pFF10E U8E pN�y TTxs request vad 18 mw�s from validation date printed in this box.
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PLEASE PRINT OR E
Date Rough-In inspection required? O Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
(��� You must call the inspector when ready! Date Ready:
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001 A-12 5/1999 STATE BOARD COPY SEE INSTRU�TIONS ON BACK OF YELLOW COPV