P - 821081'—� 11-618 �4 REQUEST FOR ELECTRICAL INSPECTION
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Minnesota State Board of Electricity
✓ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -- _ -
(651) 642-0800 www.electricity.state.mn.us
X 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.
N3P SAVER'S SWITCH
Ca/cu/ate Inspection Fee - This Inspection Request wil/ not be
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sian / Outline Lta. Xfmr.
BOO�'1
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
that I insoected the eledrical
wiihout the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amp:
TOTAL
�.�
Date
Investigative Fee r"� z Z—
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. .. . . ..... .
.,..w�.�W�.y.Y�......-.^..-.�.-.-L�-•-��.u.y��LL•WU.y� OFFICE USE ONLY This reqireat void 18 months irom validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-In ins ection re uired? ❑ Yes ❑ N�i Ins ection Other Than ,��t
9 P Q P Rough-In: LJneeady Now 0 Wili Call
��&� You must call the inspector when ready! Date Ready:
I, �] licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
ttS-OVW1A-12 5/1999 . STATE BOARD COPY � SEE INSTRUCTIONS ON BACK OF YELLOW COPY