P - 80278. REQUEST FOR ELECTRICAL INSPECTION �`�°
�_QC�Q�OQ � Minnesota State Board of Electricity -'
v,.�v v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
, (651) 642-0800 www.e/ectricity.state.mn.us � . �`
Home Duplex Apt. Bldg. Other: New Atltln
Commercial Industrial 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 on/y.
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Calcu/ate Inspection Fee - This Inspection Repuest will not be accepted without the correct
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Ximr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
In
0 to 100 Amps
Above 100 Amps
TOTAL�
ZO �'
described herein on the dates stated:
Final � � Date
Investigative Fee �J ?S ' � ° �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�y �� ��w��. OFFICE USE ONLY This request void 18 monihs from validation date printed in this box.
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*08588030* /�d
PLEASE PRINT OR TYP
Requ t Date . /\ Rough-In inspection required? ❑ Yes o Inspection Other Than Rough-In: dy Now ❑ Will Call
����" � �� You must call the ins ector when re d� Date Read
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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