P - 82245s
1-014-830 []2 REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity N:-
1827 University Avenue Suite S-128, Saint Paul, Minnesota 55704-2993 _�
(651) 642-0800 www.electricity.state.mn.us ':- '
v 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 only.
IVSP �AVER'S �WITCH
Calculate Insaection Fee - This Insvection Reauest will not be accepted without the correct fee.
Mobile Home Park Stall
Streei Ltg. / Traffic Sig.
TransformedGenerator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Suvimming Pool
IIT108Y10� BOOfII
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
I herebvi certiN that I insoected the
0 to 100 Amps
Above 100 Amps
TOTAL
�.�
described herein on the dates stated:
Special lnspect�
Final Date��jL_ d /
Investigative Fee
THlS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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I IIIIII II�I) �IIII I�III I�I� II IIIII ��I I�I OFFlCE USE ONLY Triis request void 18 moMhs from validation date printed in this box.
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*�o14s 2* � .�l4/d'�
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? � Yes C] N� Inspection Other Than Rough-In: C� Ready Now ��II Call
�� �,� ,�ti You must call the inspectar when ready! Date Ready:
I, [�icensed 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