P - 81161�
0-858-332 []0
REQUEST FOR ELECTRICAL INSPECTION B E
Minnesota State Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electrrcity.state.mn.us : '
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
N3P 3AVER'S SWITCH
Calculate
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boo
Special Insped n
Fee - This Inspection Request will not be
0 to 200 Amps 0 to 100 Ai
Above 200 Amps Above 100
INSPECTOR'S USE ONLY
I herebv certiN that I insoected the electrical installation described herein on the dates stated:
Investigative Fee �na� Dat�i�,8,,.� �_
THIS INSTALLATION MAY BE ORDERED DISL�NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�^ m� OFFlCE U8E ONLY This request void 18 months from validation tlate printed in this box.
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*08583320* 7��
PLEASE PRINT OR TY
R��� Rough-In inspection required? 0 Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now 0 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-OpOp1A-12 5/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY