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�,
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«. 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.
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*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