P - 80868o REQUEST FOR ELECTRICAL INSPECTION ��.
_� O� Y� - 6 6 6� Minnesota State Boartl of Electriciry
1821 Universiry Ave., Rm. 5-728, St. Paul, MN 55104
s Phone (612) 642-0800 ..s.e
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Re air
Air Cond. Hfg. Equip. Wa�er Hfr. Load Mgml. Other:
Dryer Range Elec Heai Temp. Service
"X" obove /he work cIo ered by ihis re Enter remarks in this space on fhe back oi fhe whife mpy only.
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Calculote Inspecfion Fee - ihis Inspection Reques� will nof be accepted without fhe correcf fee:
Other Fee M Service Entrance Size Fee # Circuits/Feeders - Fee
Mobile Home Park Srall 0 l0 200 Amps Z 0 10 100 Amps /O —
Sfreef Llg./TroHic Sig. Above 200—Am s Above 100_Amps
Transformer/Genemtor INSPECTOH'S USE ONLY � L p
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Poo� I��� I hereM cenlF �ha� I Inscec�ed fie elenrimi ins�allotion descnbea' herein
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Spe<ial I ti ^' F.�i �� �� - o�� _ZE�
Invesfi9ativa Fee � �
TMIS INSTALLATION MAY 8E ORDERED DISCONNECTEO IF NOT COMPLETED WITHIN 78 MONTHS.
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PLEASE pRINT OR TYPE
��es� Dare Rou h�in i �
`^ 8 ^spec ion requirad? f]&e. No Inspesfion O�her Than Naugh�ln: ❑ Ready Now.�/ill Call
7 na m��� �ou �,e ��,�m, whe� ,�dv�� oar� e�dY: -�
licensed contractor ❑ owner hereby request inspection of �he above electrical work ol:
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I Power
o. ��o. � ea�9e Na. � F�,e
No.
1i'i� 551Z.5
Phane No.
1v5�-57�5-t 9 �
Eu nw rnov