P - 82203REQUEST FOR ELECTRICAL INSPECTION ���°'
.� r1-411-457 07 Minnesota State Board of Electricity �N;- _
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 _
(651j 642-0800 www.e/ectricity.state.mn.us r '
Home Duplex Apt. Bidg. 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 5WITCH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
nstallations Fee # Service Entrance Size Fee # Cirouits / Feeders
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 TO�.
Sign / Outline Ltg. Xfmr. �d, �
Alarm/Remote Control
Swimming Pool
Irrigation Boom r� I hereb certity that I inspected the electrical installation described herein on the dates stated:
Rough In Date
Special Inspection
Investigative Fee � D81 J � —o �
THIS INSTALLATION MAY BE ORDERED D13CONNECTED IF NOT COMPLETED WITNIN 18 MONTHS.
.......................��.-.=.4.w�W�.�.�.�....�........................--•---OFFlCE US� ONLY This request vad 18 monlFis fiom�Validation ilate�pAMeA in this box~ —
IIIIIIIIIIIIIIIIIIIIIIIIIIIII IIININIIIIi ��. �
* 1 0 1 1 4 7* � ��Q s
PLEASE PRINT OR TY
Req�B,s�,3tg� Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
��l f � You must call the inspector when ready! Date Ready:
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 COPV