P - 81134. REQUEST FOR ELECTRICAL INSPECTION
,�'USC�-312 [2] Minnesota State Board of Electricity -_
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
• (651) 642-0800 www.electriciry.stafe.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 in this space and on the back ot ihe whlte copy on�y.
NSP 3AVER'3 3WITCH
Ca/cu/ate Inspection Fee - This Inspecfion Request wi!! not be accepted without the correct fee.
nstaliations Fee # Service Entrance Size Fee # Cirouits / Feeders
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation 800m
0 to 200 Amps 0 to 100 A�
Above 200 Amps Above 10Q
INSPECTOR'S USE ONLY
I herebvi certifv that I insoected the electrical installation described h�
�ate
Amps
Investigative Fee � � I oate�i ZS a r �
T
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request voki 78 mortths from validation dale printed in this box.
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*08583122*
PLEASE PRINT OR TY
Re�u�s� D�tg„_ Rough-In inspection required? O Yes � No Inspection Other Than Rough-In: O Ready Now � Will Call
������ You must call the inspector when readyl 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