P - 81163REQUEST FOR ELECTRICAL INSPECTION
'.J—C.�5�-328 8[� Minnesota State Board of Electricity
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2983
F (651) 642-0800 www.electricity.state.mn.us
Home Duplex Apt. Bldg. Other: New Adtln
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. Enier remarks in this space and on the back of the white copy only.
asP savER�s sw�N
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
IITlgdilOR BOORI
Fee - This Inspection Reauest will not be accedteal without the correct fee.
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certifv that I insoected the �
nvestigative ee F�
THIS INSTALLATION MAY BE ORI
II�II� I�III II�II II�II ��III �III�I �I �I
* Q�� 8 3 2 � 8*
0 to 100 Amps
Above 100 _
TO�
C�._--_ ° �°�'o A'� o� �
ED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
._ . ............... .............................._ ...............,........._.���.:.....�._....._..m..........�..
OFFlCE USE OMLY This request vad 18 months from validatlon date printed in this box.
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7V W
PLEASE PRINT OR TY
Re�g� Rough-In inspection required? � Yes O No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
� You must call the inspector when ready! Date Ready:
I, Q licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTION$ ON BACK OF YELLOW COPY