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1-O 14-552 02 REQUEST FOR ELECTRICAL INSPECTION �° H..
Minnesota State Board of Electrici ��� `�
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, 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 �� .
(651) 642-0800 www.electricity.state.mn.us ���:�
u Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial 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 this space and on the back of the white copy only.
IVSP SAVER'� SWITCH �} � � ,, �
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Calculate Inspection Fee - This Inspection Reauest 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
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. �.�
Alarm/Remote Control
Swimming Pool
I hereby certity that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom qough In Date
Special I nspection
Investigative Fee Fi�al ^` _ oa�� �^� J
! I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_.-._.-._._,_,.........��_.�.��.,...��r;.�,.�..�.� ........................ ........
I IIIIII IIIII IIII� IIIII IIIII IIII III) IIII IIII OFFICE USE ONLY This request 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 0 N6 Inspection Other Than Rough-In: � Ready Now ❑ Will Call
���a C�� '�i� You must call the inspector when ready! Date Ready:
I, [�9icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOAFD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY