P - 81433REQUEST FOR ELECTRICAL INSPECTION �
�/� [� A _ Minnesota SMate Board of ElectriciTy
�T �� 1821 Universiry Ave., Am. 5-128, SL Paul, MN 55104
Phone (612) 642-0800
Home plex Apt. Bldg. Other: New Addn
Commerciol Industriol Farm Remod e ir
Air Cond� Hig. Equip. Woter Hfr. Laad Mgmt Oiher.
�ryer Range Elec. Heal Temp. Servi<e
"X" obove fhe work covered by Ihis requesG Enfer remorks in this space and on the bnck ol �he white copy only.
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Calculofe Inspec(ion Fee - This Inspection Requesf will nof be accep�ed wifhout Ihe mrrecf fee:
Other Fee # Service Entrance Size fee # Circu�tsjFeeders Fee
Mobile Hame Park $fall 0 ro 200 Amps O to 100 Amps
Slreef Lfg./Tm(fic Sig. Above 200_Amps Above 100_Amps
T�ansformer/Generofor INSPECTOH'S USE ONLY TOTAL ���
Boom
Dme
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This reques� wid I B momhs hom wlidalion dote prinMd in this 6ox.
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* � 4 4% H 9 9� 3�* PLEASE PRINT OR TYPE ���
Requasr Date! gq Roughin inspec�lon requkedz ❑ y¢i Inspe�con Oiher iha� Roogirin: Ready Now 0 WIII Coll
�"! V �You musrcallihe I�specrorwhm.eody) Do�e Ready:
1, �hc�nsed contracfor 0 owner hereby request inspection of ihe above elechicol work at:
iob nda,e,� ts��, e�., o, uo��a Noi �,«, ._ ,,_ ._..
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Ca hacror Licenu No. Mas�er Lic. No. �PI
�"-�90 /� 65
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� � ( �, Phorie No.
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