P - 81067. o-s5s-345 �]2
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Sain[ Paut, Minnesota 55104-2993 -_ --
(651) 642-0800 www.electricity.state.mn.us � : -`
Home Duplex Apt. 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 rn this space and on the back of the white copy only.
NSP 3AVER'3 SVlIITCH
Calculate Insvection Fee - This Inspection Request will not be accepted without the conect fee.
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Special Inspect'
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
the
0 to 100 Amps
Above 100 Amps
TQl j�y�'
�D.Sb
instaliation described herein on the dates stated
Date
Finel Date ' ��
Investigative F 6 ��--.�f �'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_..,_. _.,..___- ...:.. ___. ___ __. __. - - �-- - ___._..�.......�.�..��_.__..mT.n......a...... - �
OFFICE USE ONLY This requeat void 18 months from validation date printed in this box.
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*08583452 * ���
PLEASE PRINT OR TY
R��� Rough-In inspedian required? O Yes � No Inspectlon 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 S7ATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY