P - 82238�
1� 14_997 0 REQUEST FOR ELECTRICAL INSPECTION �" E'
Minnesota State Board of Eiectricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 =_ -
(651) 642-0800 www.e/ectricity.state.mn.us
;� Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod 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.
tVSP SAVER'S �WITGH
Ca/cu/ate Inspection Fee - This Inspection Request will no�
Installations Fee # Service Entrance Size Fe
Mobile Home Park Stall
Street ltg. / Traffic Sig.
Sign ! Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
� accepted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
—r Above 100 Amas
TOTAL
�.�
I hereby certity that I ins ected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special lnsp
Final D �y
Investigative Fee ^ 2 �'- �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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� IIIII� �I�II II�II �I�II IIIII II (��I�I (I�I IIII OFFICE USE ONLY This request void 18 months from validatlon dat�� in th�x.
*1 Q149 9* • ����
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ Nb' Inspection Other Than Rough-In: C] Ready Now ❑�II Call
�un� aV •WYti You must call the inspector when ready! Date Ready:
"vW
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY