P - 82573REQUEST FOR ELECTRICAL INSPECTION i�
_ - � -014-555 50 ��
Minnesota State Board of Electricity �����`:�3�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 '�'�-�+
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(651) 642-0800 www.electricity.state.mn.us `�:;��:�
� Home Duplex Apt. Bltlg. Other: New Addn
Commercial Intlustrial Farm Remotl Repair
Air Contlitioner Htg. Equip. Water Htr. Loatl Mgmt. Other:
Dryer Range Elect. Heat Temp. Service
� aoove rne worK covered by tn�s request. Enter remarks in this space and on the back of the white copy only.
fV�P �AVER'� SWITGFi
Calculate Inspection Fee - This Inspection Request will not be
nstallations Fee # Service Entrance Size Fee
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
��i��3
�ted without the correct fee.
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
i Sign / Outline Ltg. Xfmr. �Q.fJ'Q
Alarm/Remote Control
Swimming Pool
I hereby certify that I inspected the electrical installation described herein on the dates stated:
Irrigation Boom Rough In Date
Special Inspection
Final
Investigative Fee ��,r-J2 --� "�---
THIS INSTALLATION MAY BE ORDERED DI CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 78 months from validation date�printed in this box��wy
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PLEASE P�T`�R�E�,-� �- ` ��
Request Date Rough-In inspection required? ❑ Yes ❑ No Ins ection Other Than Rou h-In:�y
P g LJ Ready Now ❑ Will Call
��„�tj� 0� `�(j� You must call the inspector when ready! Date Ready:
I, [�"�icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
tts-00001A-12 5/1999 STATE BOARD COPV SEE INSTFiUCTIONS ON BACK OF YELLOW COPY