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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity H`- _ `�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_- _
(651) 642-0800 www.electricity.state.mn.us
x Home Duplex Apt. Bldg. Other: New Addn
Commercial Intlustrial Farm Remotl 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.
N3P SAVER'S 3WlTCH.
Calculate lnspection Fee - This Inspection Request will not be accepted without the correct fee.
Installations Fee # Service Entrance Size Fee # Circuits / Feeders
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformerlGenerator
Sign / Outline Ltg. Xfmr.
AIarMRemote Control
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hersbY
Rough In
0 to 100 Ai
Above 100
TOTA�
Investigative Fee �"�� ��� `_—•–�� I`�� �� � z— I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF tiOT COMPLETED WITHIN 18 MONTHS.
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I I�II�� �II�� II��) IIII� �IIII III IIII ��I� ��I OFFICE U8E ONLY This requeat vad 18 months from validation date pri� this�
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes � N8` Inspection Other Than Rough-In: eady Now 0 Will Call
�Z�'�� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY