P - 81169� REQUEST FOR ELECTRICAL INSPECTION
k�O_858_3�4 � Minnesota State Board of Electricity -_
1821 University Avenue Suite S•128, Saint Paul, Minnesota 5510A-2993
(651) 642-0800 www.e%ctriciry.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 track of the white copy on/y.
A13P SAVER'S SWITCH
Calculate Inspection Fee - This lns ection Re uest will not be accepted without the correct fee.
Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
TransformerlGenerator INSPECTOR'S USE ONLY TO�
Sign ! Outline Ltg. Xfmr. �, �
Alarm/Remote Control
Swimming Pool
I hereb certify that I inspected the electrical instellation described herein on the dates stated:
Irrigation Boom qaugh In Date
Special Inspecti
Investigative Fee F'"ai .. o Z� � a d
THIS INSTALLATION MAY BE ORDERED NNECTED IF NOT COMPLETED WITHiN 18 MONTHS.
��� ��� OFFICE USE ONLY Thie request void 18 nantlis from validation date printed in this box. ���
� Iil�l� ����� II��� II��1(N�� (�1���� � 11�1 � ao -Sa
*08583247* �6�
PLEASE PRINT OR TY
R�i �i �,� Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: O Heady Now ❑��I 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