P - 814197.�1�-431 �
REQUEST FOR ELECTRICAL INSPECTION �� �'`�+��
Minnesota State Board of Electriciry `
1821 Universiry Ave., Rm. S-12B, SL Paul, MN 55104 �-� ��
Phone (612) 642-OB00 '�'
Air Cond. Hig. Equip. Wafer Hfr. Load Mgml. Other.
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by tbis requesG Enter remarks in �his space and on the back of the white copy �
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Calculofe Inspecfion Fee - This Inspection Requesf will na� be occepted wilhouf the cortect fee:
Other Fee ri Service Fnhance Size Fee # Circuits/Feeders
Mo6ile Home Park Stall / 0 l0 200 Amps / 0 to 100 Amps
Street Lfg./TraHic Sig. Above 200_Amps A6ove 100—Amps
Tmnsformer/Generator INSPECTOR'S USE ONLY TOTAL ,
Siqn/Oudine Llg. Xfmr. __�S
+hor 1-insoecied rhe elecrc�ml t�:mllm�o� de:cr�bd
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This reqoesf void I� hs fmm valldalian dale prinled in ihls 6ox.
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* 0 7 0 8 4 3 1 2*
P EASE PRINT OR TYPE �
Request Dme '� � Rwgh-In inspenion reqoired2 ❑ Yez Na Inspxnon Other ihan Raugh�in: .0 Reody Now WIII Call
� � lYo� musf call the inspecror when ready) Dare Ready:
I, - Ilcensed <onimcior � owner hereby request inspection of the above eledrical work at
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TE BOMD COPY E INSTHUCTIONS ON eACK OF YELLOW COPV