P - 822431�Q1 �'275 � REQUEST FOR ELECTRICAL INSPECTION �` &
� Minnesota State Board of Electricity �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 - -_
(651) 642-0800 www.electricity.stafe.mn.us : `
Home Duplex Api. 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.
h1,SP SAVER'S SWlTCH
Calculate inspection Fee - This Inspeciion Reauest will rtot be accepted without fhe correct fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig,
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
0 to 100 Amps
Above 100 Amps
TqjrQ,l�
a�
stated:
� J Investigative Fee `( � �"� � ��/— J�- °T �
� � y� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��II��� IIIII ���I� I1I�� �IIII II �v) ��II� ��; uw x OFFICE USE ONLY,This request vad 18 months from validation tlat�t� in thi�
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* 1 Q 1 5 2 9* . � 'L�`7"� �
., PLEASE PRINT OR Ti�E
Request Date yy�� I Rough-In inspection required? � Yes � No I Inspectian Other Than Rough-In: � Ready Now � Will Call
r�j 1��f.VW You must call the inspector when ready! Date Ready:
I, �icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-00001A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY