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P - 809387�4-836 � RE�UEST FOR ELECTRICAL INSPECTION �` Minnesota State Board of Electriciry 7821 UniversiTy Ave., Rm. S-128, St. Paul, MN 55104 Phone (612) 642-OS00 �°••8fl..� "x" above the work covered by this request Enter remarks in this spa<e ond on the back of tk �-IN�sF+ �,��Nrt" Calcula�e Inspec�ion Fee - ihis lnspecfion Reques� will not be occepled wi�hout tiie mrrecl Fee: Other Fee # Service En[rence Size Fee # Circui[s Mobite Home Pork Stoll 0 to 200 Amps 0 �0 100 A Street Llg./Traffic Sig. Above 200—Am s Above l OC Tmnsformer/Generafor �NSPECTOR'S USE ONLY ie Llg. Xfmr. iote Confrol Pool elxhical copy �9 S o Fee �� , I THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 18 MONTHS. OFFICE USE ONIY This request void 18 monlhs from validafion dofe prinfed in Iks bax. �IIY����� ����������I���I������II�����II� � ��370.0G� s 0 7 4 4 8 3 6 8 s ��`O°� / PLEASE PRINT OR TYPE �5'� 1– f I rza,ynn� m�Pe�no� ,��„ed? e, ❑ No m��n�o� ane, Tha� Ro�9na��. ❑ a�dy No�, f&w�ii cau �Yoo mos� calhhe Inspecmr whe ready) Dare Reody: � I, �icensed contractor ❑ owner hereby request inspection of the obove ele<frical work af: Job Address �Sheeq Boz, or RW� No.� Cly Code I�S S - :�}� �l N� �=�1 �L� �S�t3� 1�� V N�' � pplier C INC No. �— c� �t,G - Cf t-�- ��" l�'1rU 55 Ao(hp�ey5ignrnure imcror o.Owner Per I�n( � PI y�Y� V � �� . - EBOppOIA-I1 8/9b STATE BOMO COPY - SEE MSTqUCTiONS ON BACK OF YELLOW COPY