P - 82244, � =014-831 [�0
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.state.mn.us : '
Home Duplex Apt. Bldg. Other: New Atldn
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.
Calcu/ate Inspecti<
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmina Pool
NSP SAVER'S SWITCH
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereby
Rough In
� � Investigative Fee � �
THIS INSTALLATION MAY BE O
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I!I(II! i!I!i lllll I(III illll !I I!IlII II(I INI
' �*yo�4s o*
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
�.�
herein on the dates stated:
�� �at� 2 �?�t�,�
"_-_____—_____—
�D dSCONNECTED IF NOT COMPLETED WITHIN 18 A�QNTHS.
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OFFICE USE ONLY This request void 18 months from validation tlate printed in this box.
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PLEASE PRINT OR TYPE
Request Date � Rou h-In ins ection re uired? � Yes 0 Nd� Ins
g p q pection Other Than Rough-In: E�4 Ready Now � Will Call
You must call the inspector when ready! Date Ready:
I, [jQicensed 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