P - 82198•' �-� REQUEST FOR ELECTRICAL INSPECTION �` E
011-452 []8 Minnesota State Board of Electricity F- _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 ,. -
" (651) 642-0800 www.e/ectricity.state.mn.us
X Home Duplex Apt. Bldg. Other: New Addn
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 by this request. Enter remarks in this space and on the back of the white copy on1y.
NSP 3AVER'3 SWITCH
Ca/culate Insnection Fee - This Insnection Reauest wi!! not be accepted without the correct
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOifj�.__
�7t/ebl�
I hereb ceRify that I inspected the electrical installation described herein on the dates
Rouah In Date
Investigative Fee � � `�gJq�,� I Datl,�_�,�_� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�•l�•-•-•�•-.-•�•��-.�•J��� �^�•J-.�•^,-•'2f-�1•�-•-;s•-•OFFICE.U§E � h request voidLlB months from validation date printed in this box.
I IINII IINI IIIN IIIII IINI III il�l INI NII a_
* 1 0 1 1 4 8* ���� �
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ ND Inspection Other Than Rough-In: L_MReady Now 0 Will Call
�Z'T�� You must call the inspector when ready! Date Feady:
I, �] licensed 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