P - 806108(1�2-274 �
REQUESS FOR ELECTRICAL INSPECTION "�"` '
Minnesota State Board of ElectriCig� �
1ffii Universiry Ave., Rm. S-128 St. Paul, MN 5510
Phone (612) 642-0800 � � O � J '
F�
Air Cond. Hig. Equip. Water Hfr. Load Mgmf. Other:
Dryer Range Elec. Heat Temp. Service
obove /he work mvered by Ihis requesG Enler remarks in Ihis space and on tFe back of the whife copy only.
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Calculofe Inspecfion Fee - This Inspeciion Requesf wiA rof be acce
Other Fee ri Service Entrance Size
Mobile Home Park Stall 0 to 200 Amps
$freel Ltg./Tmffic Sig. Above 200_Amp
Tronsformer/Generotor INSPECTOR'S USE ONLY
$ign/Oudinel7g.Xfmr. £x�/-a2-�&-°.7
Alarm/Remote Conhol
wi��oul f{le mrrect fee:
'ee # Circuitsl�eders Fee
O to 100 Amps
Above 100_Amps
TOTAL I iQ.�•
7
i
�I insmllmlo� described herein on the dd�are�s sm o� �
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InvesfigafiveFee Ex ���
THIS INSTALLATION MAV BE ORDEHED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS: �
OFFICE USE ONLY This reqoest void 18 momhs fmm volidalion dare prinled in fhls 6ox.
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� PLEASE PRINT OR TYPE 7���
aey�asr oaa Ro�y�.m Inspecnm.equired? ❑ re, ❑� i�,�eo� ome, Tha� ao�sh i�: ❑ aeody Naw O wu caii
ra m�s� �ou me m.�m..me� �aY� oar� xeoaY:
I, ❑ licensed conlractar owner hereby requesi inspection aF ihe above electrical work at
lob Addmss �Srceet, eo,, or Roure No.� Ciy Z�p Code
s �'� �f nJ. ��. F2r�C e.�. Ss'y
Section No. Township Name w Na. Ranoe Na. Fire Na Coun
Phane No.
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SEE INSTfiUCT10N5 ON 6ACK pF YELIOW COPY