P - 81430�78-393 �
� Colculate
RE�UEST FOR ELECTRICAL INSPECTION �ff"'��»�
Minnesota State Board of Electricity �
1821 Universiry Ave., Rm. S-128, St. Pauf, MN 55�04 £�"'
Phone (612) 642-0800 � l�+"'�
Htg. Equip. Woter Hfr. Load Mgm�. Ofher
Range Elea Heat Temp. Service
k covered by this requesG Enter remorks in this space ond on the back of �h
` 'n�✓� '✓QEuC✓h��`�
n Fee - This Inspection Reques/ will not be accepted wilhout �he corred fee:
Fee # Service Entrance Size Fee # Circuits
'ark Stall 0 to 200 Amps 0 l0 700 A
fic Sig. Above 200—Amps Above 100
enB�OfOf INSPECTOH'S USE ONLY
g. Xfmr.
Confrol
copy
oare2' Z '
Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTEO IF NOT COMPLETED WITFIIN 18 MONTHS.
� OFFlCE USE ONLY This request void 18 manths from volidorion date primed In fhis 6ox_
��NU��i���� I�����I�I ������������������� � 3�6p
* 0 6 7 9 3 9 3 p s
PLEASE PRINT OR TYPE
Reques� �ok Roughin inspeciion reqoired2 ei ❑ Na Inspec�ion O�her ihon RoughAn: ❑ Ready Now ill Call
� I—�� � (You mus� call the inspecme whan ready! Da�e Ready:
I, �licensed conimctor 0 owner hereby request inspection of the above electrical work ol:
Job Address �sreet, Bax, or Rome Na.) Ciry , Zlp Cade
No. I F�re
No.
or (Tvn rming Insb�lafion ,-� � PI
�•() ;(\ L
l J:7�}5:.7 %Y7
STATE 6DARD COPY - SEE INSTRUCTIONS ON BACK OF VELLOW COPY