P - 80861814-187
REQUEST FOR ELECTRICAL INSPECTION �`�°""�R� I
Minnesota State Board of ElectriciTy �,
1821 Universiry Ave., Rm. 5-128. St. Paul, MN 55104 '���
Phone (612) 642-0800 -
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Dryer Range Elec Heot Temp. Senice
"X" above the work covered by fhis request Enfer remaiks in this space and on
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Calculate Inspeclion Fee - This Inspection Requesf will nat be accepted wilhouf the correct fee:
Olher Fee # Service Entmnce Size Fee # Circuits/Feeders
Mo6ile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Lig./Traffic Sig. Above 200_Amps Above 100_Amps
TrnnaFnrmw�/(;anernlnr INSPECTOP'S USE ONLV TOTAL
descd6ed
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Fee
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request rold 1 B manths from validotion dote primed In fhis bax.
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PLEASE PRINT OR TYPE
Re9°P'� i°�" ,`^ Rough�in inspectian required? ❑ Ves Inxpxtion Other Thon Rwghan�. dy Naw � Wi0 Call
� �p �� �Yau musl call the impec�w when ready) Date Ready:
I, icensed controcbr ❑ owner hereby request inspection of ihe obove electrical work at:
bb d ss 15reai, Box, ar re No � Gry �� Zip Code ���
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iedion Tawnship Name ar o. ftange No. Fire No. CounN _
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SEE INSTPUCTIONS ON 6ACK OF YELLOW COPY
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