P - 82354.
1-015�4C�9 � REQUEST FOR ELECTRICAL INSPECTION -E
Minnesota State Board of Electricity �
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 --- _
(651) 642-0800 www.elecfricity.state.mn.us ': - ''
Home Duplex Apt. Bldg. Other: New Addn
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
NSP SAVER'S SWITCH
Ca/cu/ate Inspection Fee - This Inspection Reauest will not be accepted without the correct fee.
Mobile Home park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TQ�I�
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereby certi that I i�spected the electrical installation described herein on the dates stated:
Irrigation Boom'` "�" Rouyn in Date
Speciallnspection �
Investigative Fee Final Date � r �,�
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
����� �I�II��I� IIIII�IIII) II I IIIII I� �� �� ��1. �I� I�� OFFlCE USE ONLY This requeat vdd 18 months from validation date printed in this box ���
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* 1 0 1 5 4 6* aa.sv ���
PLEASE PRINT OR E
Requ t Date Rough-In inspection required? ❑ Yes ❑ Na Inspection Other Than Rough-In: ❑ Ready Now ❑ 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:
E&00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY