P - 82353��20-114 [�3
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REQUEST FOR ELECTRICAL INSPECTION ,,`�'� E^
Minnesota State Board of Electricity tis— _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 --- _
(651) 642-0800 www.electricity.state.mn.us ':��
Home Duplex Apt. Bldg. Other: New Atldn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr, Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy on/y.
NSP SAVER'S SWITCH
Ca/cu/ate Inspection Fee - This Inspection Request will not be
Installations Fee # Service Entrance Size Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Gi3ntrel �
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amp�
TOTAL
� I hereby certify that I inspected the electricel installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
FNial Date
Investigative Fee 3, ( 2
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
,,.�.�.�.V.�.�....J.�.�..L��.u.4x-�.�.�..1.~.�.�....-..f.-.-.-.-.-.-.OFFICE UEE ONLY This request void 18.months from validation date Printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes ❑ N� Inspection Other Than Rough-In: �Ready Now ❑ Will Call
�_ ��.� You must call the inspecror when ready! Date Reaqy:
I, �icensed 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