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REQUEST FOR ELECTRICAL INSPECTION �.,
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minneso[a 55104-2993 _
(651) 642-0800 www.electricity.stafe.mn.us
X Hame Duplex Apt. Bldg. Other: New Addn
Commercial Intlustrial Farm Remotl Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Etect. Heat Temp. Service
'X" above the work covered by this repuest. Enter remarks in this space and on the back of the white copy only.
Calculate lnspection Fee - Thrs
Installations Fee #
Mobile Home Park Stall
5treet Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
N3P SAVER'S SWITCH
will not be acceated without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
# Cirouits / Feeders F
0 to 100 Amps
Above 100 Amps
TOT�
1 herebv certiiv that I insneded tbe electrical installatlon described herein on the dates stated:
Investigative Fee ��� �� I�� / Z—ct j I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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�•.. ..�... �.} .... .......... �.r ...... ..^� . ...,.=y. .....�-OFFICE USE ONLY TMs 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 ❑ Inspection Other Than Rough-I�: eady Now � Will Call
QSJ2��� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-0OOO1A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY