P - 81160� REQUEST FOR ELECTRICAL INSPECTION
O'V�C7-333 �8 Minnesota State Board of Electricity -
,� 1821 Univers'rty Avenue Suite 5-128, Saint Paul, Minnesota 551Q4-2993 _ -
� (651) 642-0800 www.electricity.sfate.mn.us r- �
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
N3P SAVER'3 3WITCH
Calculate Inspecti�
�ther Installations
Mobile Home Park Stall
Street Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irrigation Boom
Investigative Fee
THIS
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I hereb cert' that I ins ed the
Rouph In
Fh�al
MAY BE ORDERED DISCONNECI
I�II��) IIIII ��I�I II�I� I�I�I �II��I I�I ��I
*085$3338*
without the correct fee.
�ircuits / Feeders
0 to 100 Amps
Above 100 Amps
on the
�i-� � Oate �"�L-�—O / I
IF NOT COMPLETED WITHIN 18 MONTHS..
OFFICE USE ONLY This request void 18 moMhs hom validation date printed in this box.
,� aa ��
`T6�
PLEASE PRlNT OR TY
Requ� %� at� Raugh-In inspectlon required? 0 Yes � No Inspection Other Than Roughdn: � Ready Now L] �II Call
� You must call the inspector when readyl Date Ready:
x
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