P - 81310/7 REQUEST FOR ELECTRICAL INSPECTION �'�':" .
1 L- �° 5 3 5� Minnesota State Board of Electricity '�♦�
1821 University Ave., Rm. S-128, SL Paul, MN 55104
y' Phone (672) 642-0800 °=_�
Home
W.7Y
Other:
requesG Enter remarks in �his space ond on
Colculale lnspeclion Fee - This Inspec�ion Reques� will no� be accepted wilbou� Ibe correcl fee:
O[her Fee # Service Entrance Size Fee # Circuiks
Mobile Home Pork Sfall 0 to 200 Amps 0 to 100 A
Slreet Lip./Tmffic Siq. Above 200_Amps Above 100
INSPECTOWS USE ONLV
the eleunml
copy
O� �
Fee
' ' Fnal u� 2 �27—d�
Investigafive Fee —
THIS INSTALLATION MAY BE ORDERED OISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesi void 18 mon�hs from volida�ion date printed In �hls box.
�i�iii �ii����iiii�i�iiiii�i�iu�i�i� • d�.�
�o7��5a57* aq7�
PLEASE PRINT OR TYPE
Requezt Dale p . Rough-in inspec�ion required2 ❑ Yes (�No Inspaction Other Thon Rough-In: Reody Now 0 WIII Call
Sls 9/ (You musi coll the Inspecmr wnen ready� Dme Reody: �a0—sf
I, �licensed <onfractor � owner hereby requesl inspection of the above electrical work at
Iob Pddresx �SVeei, Box, or Rou�e No.� Ciy Zip Code
5630 —G t'� sr NE ��"����
Seciion No. Township Name or No. Ronge No. Fire Na Cauny
1LhRrCQ �10.�
lecmical Comractor �Cwnpony Name�
R'TS �C,6C Tk /
Miling Address �Cm4oc�or or Ow�r I
�'%�-o -a.s'7't'�..
uthwtzad 5'w�xe �Comracw� rn O.:
�M�
rJV 1 •)
aucnoNSOx
Phone No.
�
��