P - 81417?�?-388 �
Com mercia l I I I nd ustria l
"X"
RE�UEST FOR ELECTRICAL INSPECTION �"�" �
Minnesota State Board of Electriciry �; ��
1827 Universiry Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �,
Wafer Hfr. Load Mgml. Ofher:
Elec. Heat Temp. Service
request En�er remorks in this space and on
Calculate lnspec�ion Fee -,This Inspecfion Request will not be accepfed wilhout lhe mrred fee:
Other Pee # Service En[rance Size Fee # Circuits
Mobile Home Park Stall O io 200 Amps 0 to 100 A
Street ttg./Tmffi< Sig. Above 200_Amps Above l OC
Trons4ormer/Generotor 1NSPECTOR'S USE ONLV
) Poo� I hereb ceni �hot I inspec�ed ihe eledriml
Boom R����h-I�
mpy
,.w,.�,.� ����r�..�.. � . q�+
Imestigalive Fe � �- e) �� °'�-��- 4-- 2-v`. �
THIS INSTALLATION MAY BE OHDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE I/SE ONLY This requesl wid l�rn, r�om �auaauo� a�/�a ����x.
l Ull ll lll ll lll l l l li l�l�I II III II III II Ni i�ll
.�.
* 0 7 2 7 3 8 8 1* d��
PLEASE PfliNT OR TYPE
Request Duh Rough In inspaction required? ❑ Yes Inspecfion Other Than Raugh-In: Ready Now � Will Call
a— I �� �vo� mos� mll Me inspeaor when ready� Dote Neody:
I,�. licensed contmctor ❑ owner hereby request inspedion of the above electrical work at
Job Addmss �SneN, Box, or RoNe o.� C� ZI Code
US �a� �� "-�������, P
SMlon No. Tawnship Name or No. Ronge Nn Fre No. Cwnry ��
or �jw1ne�r re�—rro'�r� g i�ns�a�noeon��� jQ ) I�n�No. ��
�:7`JI%L-/�LIIX/"7(TL)t) ly"1 �J
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