P - 81136� REQUEST FOR ELECTRICAL INSPECTION �` E'
'�_85Q'� � O � Minnesota State Board of Electricity -
v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us :
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Senrice
x" above the work cove�ed by this request Enter remarks in this space and on the back of the white copy only.
N3P SAVER'S �WlTCH
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebv certiN that I
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amp:
Tq��
n describetl herein on the da;
Date
Investigative Fee �'� < __�.��� I �at�� 'L;�—C�d +
THIS INSTALLATION MAY BE ORDERED DISCOPINECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��M~ �f �A�����~,���A�T �����T�� OFFICE USE ONLY This request void 18 months irom vaiidafion date printetl in this box.
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PLEASE PRINT OR TY
R uest Date 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, � licensed 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