P - 823561=� 15-490 []4
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REQUEST FOR ELECTRICAL INSPECTION
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Minnesota State Board of Electricity �, .
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 a�., -- --
(651) 642-0800 www.electricity.state.mn.us
Addn
Home Duplex Apt. Bldg. Other: New
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'S SWiTCH
Calcu/ate 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 Poot-� ,-., ,�
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough
that I
0 to 100 Amps
Above 100 Amps
TQ�I�
electrical installation described herein on the date
Date
Special Inspection 8
Fina� � Z j _ � /
Investigative Fee
_ THIS�INSTALLATiON MAY BE ORDERED . CONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I I�IIII IIII) IIIII IIIII IIIII III III�I ��I OFFlCE USE ONLY TFxs request vad 18 monMs from validation date printed in this box.
*14154 4*
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PLEASE PRINT OR E
Reque Date Rough-In inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: 0 Ready Now ��II Call
�� �� You must call the inspector when ready! Date Ready:
I, [�icensed 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