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`-1 _� 1 5_27V � REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity �F-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 -_ _
(651) 642-0800 www.e%ctricity.state.mn.us
'X" above the work covered by this request. Enter remarks in this space and on the back of the white copy on/y.
Calculate Inspection Fee - This
Installations Fee #
Mobile Home Park Stall
Street Ltg./ Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr
Alarm/Remote Control
Swimming Pool .
NSP SAVER'S SWITCH
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
ma� i
without the correct fee.
0 to 100 Amps
Above 100 Amps
TO�I�
installation described herein
� � Investigative Fee � �'"'°' ('� �"�- Z�_ e Z
THIS INSTALLATION MAY BE ORDERED NECTED IF NOT COMPLETED WIJHIN_ 1_8__M�1LT1i.S,
.....................................................:.
.................. .....:s.�..�, _._._.,.._.,..........,.....
I IIII IIII) I III IIIII II IIIII I�I I�) OFFICE USE ONLY This request void 18 months from validation dat� t� In thi�.
I IIIII I I
�, o, s2 �* • L/y�'/
PLEASE PRINT OR E
Req e t Da e Rough-In inspection required? � Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�� 4►� You must call the inspector 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