P - 81198REQUEST FOR ELECTRICAL INSPECTION E
� O'��4_V22 � Minnesota State Board of Electricity —
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.e/ectricity.state.mn.us : � '
Home Duplex Apt. Bldg. Other: New Adtln
Commercial Intlustrial Farm Remod Repair
Air Conditioner 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.
NSP SAVER'S SWiTGH IIVST'ALlAT1UN
Ca/culate Insvection Fee - This Inspection Reauest will not be accepted without
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming P�I�"j C ,�
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebY certitv that I inspected the electrical
fee.
Fee
0 to 100 Amps
Above 100 Amps
TOTAL �
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in described herein on the dates stated:
�n�yauv�i uvvn� -- � Iy ROU�Gn In Date
Special Inspection �
Flnal Dajp�7 � .�.
Investigative Fee (G
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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request void 18 nanths from validation date nnied in this box.
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*08546228*
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Request Date Rough-In inspection required? ❑ Yes ❑ Inspection Other Than RoughAn: ❑ Ready Now ❑ Will Cell
�.�� You must call the inspector when read� Date Ready: �S
I, []picensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: