P - 80906. REQUEST FOR ELECTRICAL INSPECTION '``��`-�
8 0(� ��1 A O *# Minnesota State Board of Electricity „_
� J- �f 1821 UniversiTy Ave., Rm. 5-128, St. Paul, MN 55104
' Phone (612) 642-0800 '�'�' .
Home Duolex Aot. Bldct. Other: New Addn
Dryer I � Range � � Elet. Hea}� � Temp. Service �
"X" above tlie work covered by ihis request Enter remarks in fhis spoce and on the back of fh
Colculate Inspecfion Pee - This Inspection Request will not be occepted without the correct fee:
Other Fee # Servire Enhance Size Fee S Circuits
Mobile Home Park Sfall 0 to 200 Amps 0 to 100 A
�Sireel Lig./TroBic Sig. f Above 200 Ampa Above 100
Transfol rme�/Gene�O�o� I I INSPECTOR'S USE ONLV
copy
Fee
Swimming Pool I hereb cen� �ho� I ��z ened ihe elennml'�n.mllouo� desn�bed herein on the daies sm�ed
Irrigafion Baom Raugh�in Da�e
Speciol Inspectio � F, al ome ��s�G
Invesligative Fee !
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlGE U5E ONLY This request wid I B monrhs from validation date primed In rhis box.
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PLEASE PRINT OR TYPE
Beqoesi Dare Rough.n tnspenion required? ❑ Yn Na Inspec�ion qher Thon RoogMn: Ready Now � WIII CaA
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I, � licensed controctor ❑ owner hereby reques� inspection of the obove elecfricol work aY.
la6 Address (Sheet Bax, or Raule No ) Gty 2p Code
55�97-E. l•lahu6e2c� Fric�/e
Section No. Township Nome or No. Ra�ge No. Fire No. Cwnty
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- SEE INSTAUCTION$ ON BACK OF YELLOW COPY