P - 81283. . - REDUEST FOR ELECTRICAL INSPECTION ...�
7 CiC /I Minnesota State Board of Elechicity
J�� 1 J 4 7821 Universiry Ave., Rm 5-728, SL Paul, MN 55104
Phone (612) 642-0800
Home Du lex Apt. eldg. Other: New Addn
Commercial Induslrial Form Remod Re air
Air Cond. Wg. Equip. Water Hfr. Load Mgmt, Other:
Dryer Range Elec. Heaf Temp. Senice
"X" above the work vered by fhis requesf. Enfer remarks in fhis space and on ihe back of the white <opy only.
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Colculole Inspec/ion Fee - This Inspecfion Reques/ will not be occepted wifhou� the mrrect fee:
Other Fee # Service Entrance Si e Fee X Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
$heet Lla./TraHic Sia. A6ove 2Q0 . Amos Above 10� Amos
INSPECTOR'S USE ONLY
smied
imestiga�ive hee �J�^-'---- -( — / /
THIS INSTALLATIOf�MgY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This �eqamt wid 18 moNhs 6om wlidation date printed in this 6ox.
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* 0 7 5 0 7 5 4 4� vZ 76�i
PLEASE PRINT OR TYPE
Requesf Daie /�� RougMin Inspxlion required? ❑ Ves ❑ No inspecnon Olher llian Rough �n: ❑ Ready Now�Nill Call
����'7 � �Yo� must call �he inzpecroi when reody� Dore Ready:
I, �licensed conlracfor 0 owner hereby requesf inspection of the above electrical work ot
Job Address �Shee/t, �eox, or Roole No.� � L }. Ciy A Zip Code
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Sxnon Na. iownship Name or No. Range Na Fire Na. Co �y
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Power Su�
15'y'�.. C
dress (Conhactar ar ��r P�
5% �a
Gcense
Lra L �
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EBOOOOI A-11 B/96 npTE BOARD COPY - SEE INSTqUCTIONS ON BACK OF YELLOW COPY