P - 82359. -r-o�o-115 0
REQUEST FOR ELECTRICAL INSPECTION ,.���E„
Minnesota State Board of Electriciry F€- �
1821 University Avenue Suite S-128, Saint Paul, 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 in this space and on the back of the white copy on/y.
NSP SAI/ER'S SVIIITCH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee.
IncTallaTinnc Fee # Service Entrance Size Fee # Circuits / Feeders Fee
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
INSPECTOR'S USE ONLY TOTAL
I hereby certiy that I inspected the electrical installation described herein on the dates stated:
Irrigation Boopr Rough In Date
Special Insp
Fnd ? Dat
Investigative Fee � 2
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII IIIII IIIII IIIII IIIII III IIIII IIII I�I OFFlCE USE ONLY This requeat void 1B months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes ❑ N� Inspection Other Than Rough-In: I�Ready Now ❑ Will Call
�_� ��yyy� 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 5/7999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY