P - 81073w
' � 0-858-338 07
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =
(651} 642-0800 www.e/ectricity.state.mn.us �':-
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y.
N3P SAVER'S SWITCH
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Speciallnspectiq {
Fee - This
not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
-�
�stigative Fee � �
THIS INSTALlATION MAY BE
I�/III I�IfI IIIII III�I IIII� IIII�If 11,1 �I
*08583387*
that I
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
i on the dates stated:
Date
� J� Y",� _ t 7--�• d
E. OMNECTED IF NOT COMPLE7ED+WITHIN 18 MONTHS.
OFFICE USE ONLY This request vad 18 rtamhs from validalion date printed in this box.
� �,�
�� �
PLEASE PRINT OR TY
R�yg�1� Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: � Ready Now � Will Call
� � You must call the inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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