P - 81068E
REQUEST FOR ELECTRICAL INSPECTION
�`858-340 � Minnesota State Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us '': °'
Home Duplex Apt. Bitlg. 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 only.
NSP SAVER'3 SWITCH
Calcu/ate Inspection Fee - This Insnection Reauest will not be accevted without the correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby
Rough In
0 to 100 Amps
Above 100 Amps
T ��.SZ�
�n described herein on the detes stated:
Date
Investigative Fee �"'�' �;'��'�_ I vac j Z� r o�
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ _ _._,....._.._..,....: � � ..............................._...�.,....n.+.._........m......................,.._...,.....
OFFICE USE ONLY TMs request vad 18 moMhs from validation date printed in this box.
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Y PLEASE PRiNT OR TY4E
RepyQ� Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
It
You must call the inspector when ready! Date Ready:
I, ❑ licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: