P - 82575�.._..
�_O�1 A_558 a REQUEST FOR ELECTRICAL INSPECTION ��
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� f Minnesota State Board of Electricity ��*"��-�►3'
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 �t���` :-���
(651) 642-0800 www.electricity.state.mn.us �.��:�
u Home Duplex Apt. Bldg. Other: New Atltln
Commercial Industrial Farm Remod Repair
Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
x" above me work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Special Inspection
N8P SAVER'� �WITGH
Fee - This Inspection Request will not be
�e # Service Entrance Size Fee
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
that I
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without the correct fee.
0 to 100 Amps
Above 100 Amps
TOTAL
�Q.�JQ
the electrical installation described herein on the dates stated:
Date
Investigative Fee Final � ��_ __ I q�r� �� �� I
I�U�
THIS INSTALLATION MAY BE ORDERED ISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- ..- .. ...................................._.....-....-._..-.-._._._._�_..�......�. .... . .... . . . . . . . . . . . . . . . _
I IIIIII IIIII IIIII IIIII IIIII IIII IIII IIII IIII OFF�CE U$E ONLY This request void 18 months irom validation date printed in this box.
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PLEASE PRIi�'! ��YiE6s c.�
Request Date
Rough-In inspection required? ❑ Yes ❑ Nd• Inspection Other Than Rough-In: [%} Ready Now ❑ Will Call
,�n� �.�' You must call the inspector when ready! Date Ready:
I, [�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
t�s-0000iA-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY