P - 80878RE�UEST FOR ELECTRICAL INSPECTION ��
6��� O n� Minnesota State Board of Electriciry ��
� o� 1821 University Ave., Rm. 5-128, St. Paul, MN 55104
� � , Phone (612) 642-0800
Fbme Duplex Apt. Bidg. Othec S�� � i2 r�_ j���j� �New Addn
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Air
bove �he wwk mvered by /his request En/er remarks in �his space and on fhe back ot the whfte ropy only.
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Calculale Inspection Fee - ihis Inspecfion Requesf will nof be accepted wifhoul fhe correcf fee:
Other Fee # Service Entrance Size Fee M Circuit�
Mobile Home Pork Stall � � 0 to 200 Amps �� -� � 0 to 100 P
INSPECTOR'S USE ONLY
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Speciollns i � pa
Final � � p
lnvesfi afive Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED�IF NOT COMPLETE� WITHIN 18 MONTHS.
I I"� II II) I� �II �� III II I�I II �I II `.I II �I �� OFFICE USE ONLY Thia request mid 1 B momhs f�volidolion �e�med� 6ox.
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PLEASE PRINT OR TYPE
Requesf Do�e Rwgh�in inspxnon reqoiredz Ve: ❑ No Inspecrian Other iMn Raugh-In: ❑ Ready N�II Call
�� 7 �Ya, musi mll fhe inspenor when ready� Dore Feady:
I, �censed controctor � owner hereby request Inspection of ihe obove electrical work al:
lob Addrese �S�reet, Box, w Rome No.� �� G7 .� . Z�o Code
or
license
or yvner�rrormnq InstqWrioN � •
STAiE HD COPY - SEE INSTRUCTIONS ON BACK OF YELIAW COPV