P - 81257REQUEST FOR ELECTRICAL INSPECTION `�'"���
5 3 2� 5 6 8 Minnesota State Board of Electricity
4 1821 University Ave., R�1 S- 8, S. Paul, MN 55704
_ Phone (612) 642-Q80� CJ ��i .t '� �:
Farm
Cond.
"X" obo e the wo�k covered by this request. ENer remorks in this space and o Poet�white copy oi
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Cokulate Inspec�ion Fee - This Inspecfion Request will not be accepfed wi�houf kie correc� ke:
Other Fee 8 Servi<e Enhance Size Fee # Circuits/Pe rs
Mobile Home Park Stall lo mps �� 0 to 100 Am s�
Sireet Ltg./TraHic Sig. Above 200_Am s Above 100_Amps
Tronskrmer/Generolor INSPECTOH'S USE ONLY �i' � TOTA
Si n/Oudine Lig. Xfmr. �oG<.��-.. �H �yx'u CX�'�2�/O� (
Alarm/Remote Conhol ! _ r
Lc� �J.,l� /�++rtav�e.E� K�.-c F-.��+rt..Ca-�l.'�
Swimming Pool i hneb. �mH �ha� I �nscened �he elecvcal insrallafion dexri6ed herein on �he dvies smted
THIS INSTALLATION MAY BE ORDERED DISCONNECTEO IF NOT COMPLETED WITHIN 78 NTHS.
, OFFlCE USE ONLV Tfiis requast wid I B months Fom validotbn date printed in this box.
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�K � 5 3 2 5 6 8 3* PLEASE PRINT OR TYPE
Ra9��^� �/ �) Rough-in inspecnon requimdd ❑ Yes ❑ No Inspenlon qher Than Rwghln: ❑ keody Now�Hlll Coll
�� �0. 7 (Vau m�s�callihe inspeciorwhen reody� Duie Ready:
I, ❑ licensed conhactor +[�.cwner hereby requesl inspection of Ihe above electricol work at:
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nkaclo1r �Campony Name� Canrcacror Licenu No. hbs�er Lic. No. �Pbm Elec
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w Owner
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