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P - 81526REQUEST FOR ELECTRICAL INSPECTION - � 5��= 5 6 2 Minnesota State Board of Electriciry 1821 University Ave., Rm. S-128, St. Paul, MN 55104 ` Phone (612) 64 -0 Home Duplex Apt. Bldg. Other: Addn Commercial Indusfrial Farm �� Remod Re ir Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by fhis request. Enter remarks in ihis space and on the back of the white copy only. i�° V'Q �g/ � � � �� 2 at✓l ��w-� �r�Q re a� �� `� i�+'k�+v ..cC. Kc !�+ ``_ Cakulate Inspection Fee - This Inspection Request will not be accepted wifhout the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Sfreet Ltg./Troffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOT line Ltg. XFmr. mote Conhol � Pool Boom that I �� the elechical insiallation described herein on the dopes Investigative Fee "' "' - ; � f — THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This requesf wid 18 months from validation date prinled in this box. �� ) �� III II �� o ll� � * � 5 3 2 5 6 2 6�IC PLEASE PRINT OR TYPE quesf Date Roughin inspection requiredZ Yes ❑ No Inspeclion Olher Than RougMn: ❑ Ready Now Will Call 2/Z // p (� (You musf call the inspector when ready� Dale Reody: I, ❑ licensed conhactor� owner hereby request inspection of the above elech�ical work at: lob Address �Sheet, Box, or Roufe No. ^ City Zip Code S'3 �— H T�S�, /`/, L. i l' <<� �� s's'v �/ Seclion No. Township Name or No. Range No`.� Fire No. Cou �� 0�7' .�A1 n K/i �� C � � 7''-1� Power Supplier NSP Eleclrical Conhocror (C any Name� Mailing Addross �Conhacfor or Owrrer .S� � O-- Y � Aufhorized SipnaNre IConhpclor w O� ��. G �,2 --� �G YG � a �� i!/ ��V i wne No. / �l(o ^�W �6