P - 82081REQUEST FOR ELECTRICAL INSPECTION
� 0f� R xf1 Minnesota State Board of Electricity N;-
-859�VOV � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 -__ _
(651) 642-0800 www.electriciry.state.mn.us
?C Home Duplex Apt. Bldg. Other: New Adtln
Commercial Industrial Farm Remod Repair
Air Contlitioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered 6y this request. Enter remarks in this space and on the back of the white copy on/y.
Ca/cu/ate Inspectic
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
N3P 3AVER'S SWITCH
Fee - This Insvection Reauest will not be acceoted without the correct fee.
0 to 200 Amps 0 to 100 Ai
Above 200 Amps Above 100
INSPECTOR'S USE ONLY
TOTAL�g�
- I hereby certiy that I inspected the electrical installation described herein on the dates stated:
Iffi98t1011 BO � t Rough In Date
Special Inspection
Investigative Fee �nal D Z ��
wMw���THIS INSTALLATION MAY BE ORDERED DI ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��� ����T� OFflCE USE ONLY This request void 18 months from validation date printed in this box.
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*08598088* ��l`3
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ MO Inspection Other Than Rough-In: �eady Now ❑�II Call
�� 4(� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
�o wv� � n- i c oi i aay
J I A I t CUAFiU GUF'Y SEE INSTRUCTIONS OM BACK OF YELLOW CAPY