P - 82360E
���015-828 �5 REQUEST FOR ELECTRICAL INSPECTION ;
r Minnesota State Board of Electricity F:. ,
1821 University Avenue Suite S-128, SaiM Paul, M'mnesota 55104-2993 _ <
(651) 642-0800 www.e/ectricity.state.mn.us `�.-'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Contlitioner 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 antl on the bactc or tne wnae copy onry.
NSP SAVER3 sWITCH
Fee - This Insvection Request will not be accepted without the correct fee.
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / Traffic Sig. Above 200 Amps
TransformedGenerator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
� I hereby certi(y that I ins ed the
Irrigation Boo , `� �i .' _ Rouah In
0 to 100 Ai
Above 100
TOTAL
�.�
herein on Me dates
' FinN /� � � Date
Investigative Fee �� � - � Z ' ° �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
•-,_•_,_ _._•_'--._'_•_•_�'_•_'_,'��'_ __'_••—_'_-,___'_-..,.�.__...�,� ..............��............., .�.....__ ..�...................................
I�IIII� �I�I� IIII� �I��� IIII� (�I �II�� �I �I OFFICE USE ONLY This request vad /8 monffis from validation date printed in this bax.
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*10158 5* �
PLEASE PRINT OR TYPE
Request Date Rough-In inspection required? ❑ Yes � No` Inspection Other Than Rough-In: �TReady Now ❑ Will Call
w�� �.yM� You must call the inspector when ready! Date Ready:
I, [jdicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOtA-12 5/1999 STATE BOARD COPY SEE INSTRUC710NS ON BACK OF YELLOW COPY