P - 82206HE
• � 'O � � _^ GO � REQUEST FOR ELECTRICAL INSPECTION
`'tV Minnesota State Board of Electricity F:- -�
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993 =_ -
(651) 642-0800 www.electriciry.state.mn.us . '
Home Duplex Apt. Bidg. 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.
N3P �AVER'S SWITCH
Calculate Inspection Fee - This Inspection Reouest wil/ not be accepted without the correct
Mobile Home Park Stalf
Street Ltg. / Traffic Sig.
Transformer/Generator
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
Swimminq Pool
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
Rough In
0 to 100 Amps
Above 100 Amps
on the dates steted:
� � Investigative Fee � � � �- � ��/'/ —�/ �
THIS INSTALLATION MAY BE ORDERED DI IVNECTED !F NOT COMPLETED WITHIN 18 MONTHS.
................................................................�.............y..�............... .. ........................................... ........................_...., .
� OFFICE USE ONIY This requesl void 18 months from validation date printed in this box. I
I IIINI INII IIIII Ilill NIII III I�II NII III a� _� �
�* 7 o y, 4 1*� � ��j ��'
PLEASE PRINT OR TY
Request Date Rough-In inspection required9 � Yes ❑ No Inspection Other Than Rough-ln: � Ready Now ❑ Will Call
�2��� You must call the inspector when ready! Date Ready:
I, � licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
EB-OOOOtA-12 5/t999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY