P - 81432REQUEST FOR ELECTRICAL INSPECTION
n2 � i� C 0 O � Minnesota State 8oard of Electricity
"'�' � J 7821 Uni��ersiry Ave., Rm. S-128, SL Paul, MN 55104
� Pho�e (672) 642-0800
Home Duplex Apt.8ldg. O�her: New Addn
Commerciol Indusfriol Form Remod Re Ir
Air Con Hfg. Equip. Wofer Htc Load Mgmt. Other.
Dryer Range Elec Heat Temp. Service
"X" above the worR covered by �his reqoes[ Enter remarks in �is space ond on the back of the white copy only.
F' �� t� � `-' "" 1 �'' �!' � / ��./ � / J �V V � i 1
culate lnspxtion Fee - This Inspc
Other F¢e
Mobile Home Park Stoll
Street Ltg.JTraffic Sio.
Boom
Reques/ will not be accepfed wilhou� the wrreci fee:
Service Enhance Size Fee # Circuits
I 0 ro 20D Amps 0 l0 100 A
INSPECTOP'S USE ONLY
�ha� �
Fee
Sc
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN MONTHS.
OFFICE USE ONLY This requeslwid 18 momhs hom validatian dok printed In Ihis 6ox.
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* � 4 4% 5 � 0 0* PLEASE PRINT OR TYPE
R sl D9ate`� [� Roogtwn Inspaction required? ❑ Yes No Inspec�ion Oiher ihon RougMn: eody Now � Will Coll
�� (�VF /� (l'o� musr call �he inspedw whe� reody� Core Ready:
1, � licensed mntmclor � owner hereby requesl inspection of Ihe above electrical work at:
1ob Address ISVee�, Bw, or Roote No.) Gy Zip Cade
(��to A�l� �T N. � �2��1.G�-�I, �S�/�3L
No. I Townsh(p Nome or No. Rarge No. fim No.
-� �u. t r�
lupplier Address
d Controctor (Canpony Np� Convanor Licei
� /?�a (..�—�'C—�c�f�Z L� C'�69'0 �
Address �C nkacror or Ow Performing Insblhn
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