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P - 82638i 1'014-834 � REQUEST FOR ELECTRICAL INSPECTION `� �' . Minnesota State Board of Electricity H: . a 1821 University Avenue Suite 5-128, Saint Paul, Minnesoia 55104-2993 � �`: +*° 1�:..; � (651) 642-0800 www.electricity.state.mn.us �:��. 'X" above the work covered by this request Enter remarks in this space and on the back of the white copy only. Calculate Mobile Home Park Stall Street Ltg. / Traffic Sig. Transformer/Generator Sign / Outline Ltg. Xfmr. Alarm/Remote Control Swimming Pool Irriaation Boo� n � fVSP �AVER'� �WITCH Fee - This Inspection Request will not be �e # Service Entrance Size Fee 0 to 200 Amps Above 200 Amps INSPECTOR'S USE ONLY I inspected the without the correct fee. Circuits / Feeders 0 to 100 Amps Above 100 Amps TOTAL �. s� described herein on the dates stated: I I Investigative Fee Final ' // - T �f — -- �_. �� ( �( �. O THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. ......,.............� ._....� .......... ....,..-.....,.........._.,_..,........ . ... ,..... ............................,_ .......,.._.... W u..yu_:... �.�....,�...._.........0 . � T �(IIIIII IIIII IIIII IIIII IIIII II IIIII IIII I OFFICE USE ONLY This request void 18 months from validation date printed in this box. � � �� ao�67� *10148 44* • l���� PLEASE PRINT OR TYPE Request Date 4 Rough-In inspection required? ❑ Yes ❑ P% Inspection Other Than Rough-In: LJ Ready Now ❑ Will Call ,��a `�3'�� `]Q� You must call the inspector when ready! Date Ready: I, [�1icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: tC-UUUUIH-1"L S/1999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY