P - 82202u
�-01 �-455 � REQUEST FOR ELECTRICAL INSPECTION �` E
Minnesota State Board of Electricity
1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �_ - _
(651) 642-0800 www.electriciry.state.mn.us "�.- '`
Home Duplex Apt. Bltlg. Other: New Addn
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 this request. Enter remarks in this space and on the back of the white copy only.
N3P SAVER'S SWITCH.
Calcu/ate
Mobile Home Park Stali
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
AIarMRemote Control
will not
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
0 to 100 Ai
Above 100
fee.
� Investigative Fee � � r"w � �� - — ��° f J�— (7 U I
THIS INSTALLATION MAY BE ORDERED DI NNECTED IF NOT COMPLETED WI HIN 18 MONTHS.
••�•••.� b.�•u��•LL•l••..•',••~•-•�•.-•-.;.`•.••��•-��•-•--.--OFFICE USE�ONLY This requesl vad 18 months from validatian date priMed in this box.
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* 1 0 1 1 4 1* � ���C�
PLEASE PRINT OR TY
Re uest D��� Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: � Ready Now O Will Call
You must call the inspector when ready! Date Ready:
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