P - 81423�-948 �
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REQUEST FOR ELECTRICAL INSPECTION �x� �.�»
Minnesota State Board of Electricity
1821 UniversiTy Ave., Rm. S-128, SL Paul, MN 55104 ��
Ptwne (612) 642-0800
Au l,ontl. F1tg. tquip. Wofer Hir. Load Mgmt Ofher.
Dryer Ronge Elec. Heat Temp. Service
"X" above the work covered by this requesG Enter remarks in this space and on Ihe back of fhe while copy only.
�l/a-1L- �° ° �'a'� D v,F'�fi���D
5'��' ��
Cal<ulafe Inspecfion Fee - This Inspeciion Requesl will nol be atcep�ed wifhouf fhe mrrect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 tu 200 Amps 0 to 100 Amps
Sfreef lfp./Traffic Sip. Above 200_Amps Above 100 Amos
INSPECTOR'S USE ONLY
Boom
elecfricollnsmllmbn described hereln o� ihP d�les smied
...."..a_..._ . " _— _ e�i
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 18 MON HS.
u OFFICE USE ONLV This requeslwid 1� s Fom mlidotion da�nted in this box.
I� II ��I lI III �III I� II I III II I,f,l ��I I�I
* 0 6 8 2 9 4 8 5* �% �
- PLEASE PRINT OR TYPE
Roug6in inspec�ion required? ❑ Yes Inspectian Other Than Rough-In: ❑ Ready N Will Call
� �You mos� coll �e inspecror when ready Dore Ready:
conlmctor ❑ owner hereby request inspection of the above eleclricol work at:
Boz, or Rwfe I�IeJ Ciw ��., l'..,,le
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STATE BOApO COPY -_SEE INSTHUCTIONS ON BpCK
COPY
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