P - 82355o'
�_O-I �_Qn� � REQUEST FOR ELECTRICAL INSPECTION E
� 0C Minnesota State Board of Electricity '�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 —
(651) 642-0800 www.electriciry.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.
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Calcu/ate Inspection Fee - This Inspection Reauest will not be accevted without the correci fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimminq Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
that I
0 to 100 Amps
Above 100 Amps
TOTAL
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�n described herein on the date
Date
I � Investigative Fee � ������� � �����_ �����3—� z—OJ
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII (IIII IIII) III�I IIIII III IIIII � I�I OFFICE USE 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 ❑ Nb' Inspection Other Than Rough-In: Ready Now ❑ Will Call
�� � You must call the inspector when ready! Date Ready:
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