P - 814317�:1.-238 �
REQUEST FOR ELECTRICAL �NSPECTION ��'�`��
Minnesota State Board of Electriciry �
#
1821 Universiry Ave., Rm. S-128, Si. Paul, MN 55104 �., .�'
Phone (612) 642-0800 ���!`--
Ofher.
"X" above fhe work covered by rhis request Enter remarks in thiq spoce ond on ihe back of lhe whi�e copy only.
�o-U.Q� ./.�jL(J-C-Ge V"v�e.e�
(l�,c:�2 �.e��°'"' � �QiO �
Colculate Inspec�ion Fee - This Inspecfion Reques/ will not be occepfed wilhoW lhe corred fe :
Other Fee F Service Enhance Size F p Circuits/Feeders Fee
Mobile Home Park Stoll 0 to 200 Amps / 0 to 700 Amps d"j
Sireet Llq./7raffic Sip. Above 200—Amps Above 100_Amp
INSPECTOfl'S USE ONLY
,-E ^
� Invesfiga}ive Fee � � �C�r =-�j -/� �/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 78 MONTHS.
OFFICE USE ONLY This requesf void 18 nnn�hs fmm wlldation cam prinled in ihls box.
i� uiliiiiii���iuiiiii� iiiiiin���� • �a5�
* 0 7 L 1 2 3 8 6 s "t7�
PLEASE PRINT OR TYPE
R�est-le ��� � Roug6in Inspection requiredZ Yes ❑ No lospecrian O�her fian Rough-In: ❑ Ready Now WIII Call
� Q'ou musi call Ilie inspMOr when readyl Dare Ready:
I, licensed controctor ❑ owner hereby requetl inspecfion of iFie above electrical work ot:
lob Address �Sheer, eox, or Ra� No.� Gy Zip Code
. �_� .. n .,� �..a-� e en _,—,_
Phane No.
� /1 t'7� �t (i!.
No. MoAer Gc.
a���. ,a�� ,�9 �� � �� 2 G�3 � r=J �no�a �a
iivi � mii..�u ` �.�-�bPC7