P - 82239�.�1 � 5_2G7 � REQUEST FOR ELECTRICAL INSPECTION " E
'V V Minnesota State Board of Electricity �
' 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 551044993 �:_ _ _
' {651) 642-0800 www.electricity.state.mn.us `�. -'"
Home Duplex Apt. B�dg. 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 only.
Calculate Inspection Fee - This
Jther Installations Fee #
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transiormer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
ir
Irriaation Boom o_
I�P �AVER'S SWITCH
will not be accented without the correct fee.
cnat i
# Circuits / Feeders Fee
0 to 100 Amps
Above 100 Amps
TOTAL
�.�'J�
allation described herein on the dates stated:
Investigative F��� � ���i�-� I �Z —�- ��i I
THIS INSTALLATION MAY BE ORDERED NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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� 'u ���^� OFFlCE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-In ins ction r uired? L7 Yes � N6` Ins
, g pe eq pection Other Than Rough-In: Ready Now ��II Call
i 14 �ffVV1 You must call the inspector when ready! Date Ready:
V 1 .M�V
I, [�4icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-0�01A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY