P - 81164,; REQUEST FOR ELECTRICAL INSPECTION
d—v�V-319 []7 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" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
NSP SAVER'3 3WITGH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
0 to 100 Amps
Above 100 Amps
TO
Or �
n described herein on the dates stated:
Date
Special Inspe�il�n A J 1
Final Da
Investigative Fee �"-
THIS INSTALLATION MAY BE ORDERE NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OPRCE USE ONLY This request vad 18 months from validation date printed in this box. mrt
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PLEASE PRINT OR TY
Regu��t, qatp,_ Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: � Ready Now O Will Call
���a�� You mus[ call the inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electricai work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY