P - 82638i
1'014-834 � REQUEST FOR ELECTRICAL INSPECTION `� �' .
Minnesota State Board of Electricity H: . a
1821 University Avenue Suite 5-128, Saint Paul, Minnesoia 55104-2993 �
�`: +*° 1�:..; �
(651) 642-0800 www.electricity.state.mn.us �:��.
'X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boo� n �
fVSP �AVER'� �WITCH
Fee - This Inspection Request will not be
�e # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I inspected the
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
�. s�
described herein on the dates stated:
I I Investigative Fee Final ' //
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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� T �(IIIIII IIIII IIIII IIIII IIIII II IIIII IIII I OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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*10148 44* • l����
PLEASE PRINT OR TYPE
Request Date 4
Rough-In inspection required? ❑ Yes ❑ P% Inspection Other Than Rough-In: LJ Ready Now ❑ Will Call
,��a `�3'�� `]Q� You must call the inspector when ready! Date Ready:
I, [�1icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
tC-UUUUIH-1"L S/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY