P - 81435�.C��b`J' .'7 �
Home Duplex
REQUEST FOR ELECTRICAL INSPECTION €�'�'��
Minnesota State 8oard of Electriciry
1821 University Ave., Rm. S-�28, St. Paul, MN 55104 �
Phone (612) 642-OB00 .^�"
Air Cond. Hfg. Equip. Wafer Hlr. Lood Mgmt Other: �
Dryer Range Elec. Hea� Temp. Service
"X" above fhe work covered by Ihis requesL Enfer remo�ks in fhis space and on �he back of �he white <opy only.
��,�{,� / � �7'l l � ��/Y1
Calculate Inspec�ion Fee - This lnspection Requesi will not be accepfed without �he wrred fee:
O[her Fee # Servire Entrence Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Am s Above 100_Amps
Transformer/Genemtar INSPECTOR'S USE ONLY TOTAIrt ,r
ine lig. Xfmr.
mote Confrol
� Pool
800m
I I�soeaed ihe ele�mml insmllmlon dascdbed he�ein on the do�es stared
THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 16 MONTHS. �
� OFFICE USE ONLY ihls reques�void 16 monfhs 6om validotion dale prinled in this box.
��� ���I � ��0 �� �� �{�N��1���n��hl �:�. �
� 0 7 2 5 6 9 5 1 * �0�7
PLEASE PRINT OR TYPE �
Reqoen Date Raugbin inspenion required? � Yes ❑ No Inspection Olher ihon Roogh-In�. ❑ Ready Now Will Call
�—� —q 9,�o� mvst coll Ihe inspecror whe� reody) Dme R�dy
I, � licensed conlmctor ❑ owner hereby request inspection of ifie above electrical work at
Job Address �Sneer, Box Rou� No � Gy Zip Code
1 �?J f�v Yc,�t.�� �� �'/c� ��e.
Sec�ion No. Tawnship Name or No. Ronge No. Flre No. Coo ^ ��
�
Camraclor (Compa�y Name)
IUei(as Electric, Inc.
MN
P �Na_� _ ^�� � J ,
// Y �s�
�1�1a/�
m��y�,f�BJ`� �6����{3�-�970�
BOAPU COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY