P - 80888REQUEST FOR ELECTRICAL INSPECTION ��
CC i /I Minnesota State Board of Electriciry
L}{J� (°i H � 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �-�
Phone (612) 642-0800 �
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Commercial Industriol Farm Remod e
Air Cond. Hig. Equip. Waler Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by this requesG Enter remarks in this space ond on �he back of rhe white copy only.
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Calculafe Inspection Fee - This Inspection Requesf will nof be occep�ed wifhout �he correcf iee:
Other Fee # Service Entrance Size Fee 8 Circuits/Feeders Fee
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps <o.
Slreet Ltq.(Troffic Siq. Abave 200_Amps Above 100—Amps _
INSPECTOR'S USE ONLY q �
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i 6o.oM, �oniF, �6,.r I I���.Y�ad ae nlnmirnl In:�allouoo dnscribed hereln on fhe dales st
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Invesfigafive�ee� '� s '� ""' "' '
THIS INSTALLATION MAY BE ORDERED D�SCONNECTED IF NOT COMPLETED WITHIN 18 MONTFiS.
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OFFICE USE ONLY This request void 78 months from validofion dale prinhd in this box.
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PLEASE PRINT OR TVPE
Reques� Daie Roogh-in inspec�ion requlred? ❑ Yes � Inspectian Other Than Rough�ln: eady Now � WilbCa�l
�f (Voo mvst call the mspector when ready� Dare Ready:
I, icen:ed contractor � aw�er hereby request inspection oi the obove electrical work at:
Job Address ISheel. Box. or Roure NoJ Ciro 2io Code
Namc or No.
Phone No.
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Au�horieed 5' naNre (Commciw or O Perfaming InsrollaFon� Phone Na.
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E6-0 A-I 7 8/96 STATE BOANO WPY -$EE INSTNUCTON4 ON BACK OF YELLOW COPY