P - 79425soz-363 �
/
'�? �hs
Calculate 7nspecl
REQUEST FOR ELECTRICAL INSPECTION �a.�`���"`�`�,'�
Minnesota State Board of ElechiciTy ��-'�
1827 University Ave., Rm. 5-128, St. Paul, MN 55104 �� ��
Phone (612) 642-08�p , � ..
/., JJ �
I �thec ]�W7 � New Addn
�g. tquip. Woter Htr. Load Mgmt Ofher. "-
ange Elec. Heaf Temp. Service
✓ered by fhis requesG Enfer remarks in this space and on lhe back o/f ,�he w�hitye wpy only./
F.'J�.7 /GO /1��/l �JG tu�fa� C�i�rGvi'h
�S
/I �u/.-,'-7 ,�c,`,-�S�OS.,z j �J�,,�.,.sLr�--
e- This Inspecfion Requesf will not be occepfed withoui �he correcf ke:
Fee # Service Entrance Size Fee N Circuits/Feeders Fee
Mobile Home Park $all
Sfreel Ltq./Traffic Sip.
Boom
�AboJe 200_,
INSPECTOR'S USE ONLY
the
R7
desdbed herein on the dmes smted
� Invesfigative Fee � � � ��
THIS INSTALLA770N MAY BE OHDERED DISCONNECTED IF NOT COMPLETED
OFFICE USE ONLY Thie raques� void � omhs bom vo0da�ion dale prinRd in ihls box.
INI111111111111n1 IfNllll II Ili1 NiNNNI ,����
2 3 6 3 2 f��j,S(?
PLEASE PRINT OR TYPE
Raquen Date Roughin inspedion reqvired? ❑ Ves �No Inspeclion Oiher ihan Rough�in: ❑ Ready Now 0 Will Call
/C._ �.q' —�� �, I�oa must coll ihe inspecror when ready) Daie Ready:
I, �I�icensed controctor ❑ owner hereby request inspecKon of the above elechical work at:
lob Ad ress Srve v, Bo., or RoNe No.� Cly Zip Code
,s� - ,�-; : /., S� �; �o' ,
Sec�ion No. Township Name or No. Ronge Nn Fire No. uny ///
,�_ f��� _ .�� ✓�.ri/ .�
18
Sa
-0^�- I
(commao� or
"E
J
— c �i �