P - 81326REQUEST FOR ELECTRICAL INSPECTION
��O/S �� 7 Minnesota State Board of Electricity
J� �� � � 1821 Universiry Ave., Rm. 5-728, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplez Apt. Bldg. Other: t � New Addn
Commercial Indushial Form A � C I Remod Re air
Air Cond. Hfg. Equip. Wafer Hh. Load Mgmt Ofher:
D er Range Elec. Neai Temp. Service
"X" above the work overed by �his request. En/er remarks in this space and on fhe bock of fhe while copy only.
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Calculate Inspection Fee - This Inspecfion Reques� will nof be a<cepfeJ�wiPoo�� c�rect fee:
Other Fee Service Entrance Size Fee e Circuits/Feeders Pee
Mobile Home Pork Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200—Am s Above 100_Amps
TronsFormer/Genemfor INSPECTOB'S USE ONLV TOTA�t �
C:..../(l..d:....lb. Y{.... /�
linsoecied�he eken'ical
Boom
TMIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHIN 19'MONTHS.
OFFIGE USE ONLY This requeat void 18 mon�hs Irom validofion dare printed in Ifiie 6ox.
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* � 5 3 '�L 5% 7 4* pLEASE PRINT Ofl TYPE
Reqoes� ce RougMin inspectian requiredz Yes ❑ No Inzpactian Oiher l)wn Pwu9�n: ❑ Reody Now O Will Call
�vw m�st mll �he in:p mr when reody� Oare Ready
I, ❑ li nsed controcror�owner hereby reques� inspection of the obove eleclrical work af:
Job Address �SkeM, Boz, or Rwk No.� Ciy � Zip Code _
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� j .- �> i ., .:. Phone No. . _ .
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License No.
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