P - 82357� � _O � �'Q�O � REQUEST FOR ELECTRICAL INSPECTION
�� Minnesota State Board of Electricity `3
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 5550A-2993 -- -
(651) 642-0800 www.e/ectricity.state.mn.us iffi�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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 onry.
Ca/culate Inspecti�
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / OuUine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Special Inspecti . � �
NSP SAVEf7S SWITCH
Fee - This Inspection Request will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiiv that I insoected the electrical
�ted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
�.�
Date
dates stated:
I Investigative Fee `'' ��i ,� I r���a� � �� j'= � �— �( �
THIS INSTALLATION MAY BE ORDERED DISC�ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIII ( I�II IIIII IIIII IIIII �I I IIII) I'N �I OFFICE USE diLY fThisLrequest void 18 months from validation date printed in this boz.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes ❑ N9 Inspectlon Other Than Rough-In: LT Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I, j�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY