P - 81172T
� 0-858-316 0
REQUEST FOR ELECTRICAL INSPECTION �` F
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. Entei remarks in this space and on the back of the white copy only.
N3P 3AVER'3 3WITCH
Calculate lnspecti�
�ther Installations
Mobile Home Park Stall
Sireet Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
AlarmlRemote Control
Swimming Pool
Irriqation Boom
Fee - This
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
without the correct fee.
Circuits ! Feeders Fee
0 to 100 Amps
Above 100 Amps
TOl(�'
� . S'�
�n described herein on the dates steted:
Date
. v
Investigative Fee �= —p1
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
���}��R.M���� ���.�.w�������T.�J��� OFFICE USE ONLY This requesl vdd 18 months from validation date printed in this box.
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PLEASE PRINT OR
Re�� Rough-In inspection required? Q Yes O No Inspection Other Than Rough-In: � Ready Now � Will Call
You must call the inspector when readyl Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY