P - 80977E
REQUEST FOR ELECTRICAL INSPECTION
�„$�'7_2,48 � Minnesota State Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
' (651) 642-0800 www.eleciricity.stafe.mn.us :-
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
SpeciallnspeC3g �
Fee - This Insnection Reauest will not be accepted without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiiv that I
0 to 100 Amps
Above 100
Date
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urvesagative ree � � L�...rt" (/'-' /^/,L
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT C0IAPLETED WITHIN 18 MONTHS
� OFFICE USE ONLY This request void 18 months from validation date printed in this box,
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PLEASE PRINT OR TYPE6��
sst ate Rough•In inspection required? 0 Yes No Inspection Other Than Rough-In• R /�y� Now7n�/yy��0 Call
%L� You must call the inspector when r ! Date ReadY� �/��U! �'
I, �j licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
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EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY