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P - 81153� � REQUEST FOR ELECTRICAL INSPECTION � a'858`28g � Minnesota State Board of Electricity -_ 1821 Universiry Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 (651) 642-0800 www.electricity.state.mn.us : ` Home Duplex Apt. Bidg. Other: New Atldn Commerciai Industrial Farm Remod Repair Air Contlitioner 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 only. , NSP SAVfR'3 3WITCH Calculate lnspecti� �ther Installations Mobile Home Park Stali Street Ltg. / Traffic Sig. Transformer/Generator Sign / Outline Ltg. Xfmr. Alarm/Remote Control Swimming Po,pl _ Fee - This lnspection Request will not be accepted without the correct fee. ae # Service Entrance Size Fee # Circuits / Feeders 0 to 200 Amps 0 to 100 Amps Above 200 Amps Above 100 Amps INSPECTOR'S USE ONLY TO�L�, �'�ev c «. I herebvi certiN that I inspected the electrical instellaHan described hereirt on the dates Speciallnspection - Investigative Fee F�� D� � 7— � J ......__._.._. .. .TF1��:IW�Tp�LJ.ATION MAY BE ORt�RED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 moMhs from validation date printed in this box. IIIIIIIIIIiIIIIIIIIIIIIII�IiNi��Inl�� � a� � *08582892* 76J� PlEASE PRINT OR TY Request Date Rough-In inspection required? � Yes ❑ o Inspection Other Than Rough-In: Ready Now 0 Will Call ����� You must call the inspector when ready! Date Ready: I, �J ficensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: °°'°°°°'A-iz 5n999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY