P - 81316nG'7c REQUEST FOR ELECTRICAL INSPECTION .,�
5 3sL`� J 1 O Minnesota State Board of Electricity
1821 Universily Ave., Rm. 5-128, St. Paul, MN 55104
, Phone (612) 642-0800
� Calculale
POOI
Waler Htr. Load Mgmt. qher.
Elec. Heol Temp. Service
reques[ Enter remorks in �his space ond on
Fee - 7his Inspedion Request will not be occepted wilhout lhe cor�ect ke:
Fee # Service Entrance Size Fee 8 Circuits
rk Stall 0 fo 200 Amps to 100 A
Sig. Above 200_Amps Above 100
era}o! MSPECTON'S USE ONLY / ��/
i.hTIL �< <t�` � `�� '°� " " ��
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copy
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Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE 113E ONLY This reqcest void 1 H monihs hom wltdation date prinred in �his boz.
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*\ 0 5 3 2 5 i 6�a �k pLEASE PRINT OR TVPE
Requ si ^Ie1 � RwigMin inspecnon required? Yes ❑ No Inspeclion ONier TFan RougMn: ❑ Reody Now Wili Call
So� (You m�s� call ihe inspeclor when r dy� Dare Raody:
I, ❑ licensed conRactor � owner hereby request inspeclion oF the above elechical work aY. .
Job Address 15veet, 8w, w Roore No.� Cny � Zip Gode
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STATE BOARD COPY - SEE INSrRUCfION5 ON BACK OF YELLOW COW