P - 80936532-598 �
Commercial
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RE�UEST FOR ELECTRICAL INSPECTION
Minnesoha State Board of Electriciry
182/ University Ave., Rm. S-128, SL Paul, MN 55104 --
Phone (612) 642-0500 �n. _
horm � Y r �
Woter Hfr. Load Mgmt. Ofher,
Elec. Heat Temp. Service
requesG Enter remarks in this spoce ond on
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� Cakulale Inspec�ion Fee - This Inspecfion Requesf will no/ be accepled wirhouf �he mrrec/ fee:
Other Fee # Service EM�a�e Size Fee it Circuits
Mobile Home Pork S�all l0 200 Amps 0 to 100 A
Sfreef Lfg./TroHi< Sig. Above 200_ Am s Above 100
TransformedGenemror MSPECrOfl'S USE ONLY
Control
copy
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ImesKgalive Pee �" --�2 _ �C"�
THIS INSTALLATION MAY BE ORUERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This requesf void 18 monihs hom validmion dore pirned in this box.
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Reqcesr Date �` xo�a�.m m,�ro� ,ey„�,edz ❑ ve, i��no� aha. mo� Roog � �dy ❑ wu can
9• �� / 9 �'lo� muv mll �he i�specror when reody) Dote keady�
I, �lcensed contmctor ❑ owner here6y request inspecfion of �he above elecfriwl work at:
lob Address (SVee6 Box, or Rouk No.) Cly Zip Code
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Sxnon No. Towoship Nume a No. Range No. Fire No. Cwmy
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:OPY - SEE INSTBUCTIONS ON BACK OF YELLOW CWV