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P - 80886REQUEST FOR ELECTRICAL INSPECTION "'��� �(�(� (�(�p Minnesota State Board of Elec[ricity � I,j'U ` J 7 O � 7821 Universiry Ave., Rm. 5-128, St. Paul, MN 55104 �� s Phone (612) 64&0800 Home Duolex Aot. Blda. Olhec New Addn "X" a�3 �r� e� d by% requesG E� Do fj� Z�,�s �� G�����' Calculale Inspection Fee - This Inspecfion Requ� O(her Fee � Ser Moblle Nome Park Stall �o Sfreel Lfq./Traffi< Siq. Abc I.f� Load Mgmt. Other. Temp. $ervice narks in fhis space ond on e bock of the � SC/li��c�j �s, Cv H/L-e. will not be e Entrance NSPECTOR'S USE ONLY n!N-��=�� �T wi(hout lhe cor�eCf fee: Fee # Clrcuits 0 to 100 A herein on the dofes �� I_TXIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT COMPLETED N i.. _..___ __ ._ _..._ ._. . _. . ---_ I���I II �II I II II III � III�I III � II I IIII OFFICE USE ONLY This request wid � 8 menths�voli * 0 6❑ 0 9 9 9 9 s PLEASE PRINT OR TYPE Reqoest Da Roogh-in inspection requiredz ❑ Yes No Inspenion O�her Than Rough-In: �S �Vov must mll Il�e Inspecmr when reody Dare Ready: I, �licensed wntroctor 0 owner hereby request inspedion of ihe obove electrical work at: bb yjdress (�e� :, or Rou��/ ��� / qy�r `/ 6'2 r :�=/Z�'�.�'/����«��-� s �Conhac�a «Ownn Perlarming Insfullofion� ' �ok _���1�' _�ii Fee .3 �/ »e prinfed inthb box. 3o.sa � 93� idv Now 0 Wtll Coll _ I �i1 s�/ 1/`� ���� �r�. se No- Moster lia Na. fPlanl Elxt Onlvl c < <. � � �.. STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLAW COPY �