P - 80618� REQUEST FOR ELECTRICAL INSPECTION �,�:�'��
6:1,`% �� 7 C � � Minnesota State Board of ElechiciTy �����,
O li G i J 1827 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �?���
)( Home Duplex Apl. Bldq. Ofher: New Addn
Dryer Range Elec Heat Temp. Service
"X", ^abo+ve(�the` work covered by this re(quesG Enter remorks in �his spoce ond on the back of th p
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Cakulate Inspection Fee - This Inspection Requesf will nof be accepled wi/houf �he mrrect fee:
O[her Fee k Service Enhance Size Fee # Circuits/Feeders Fee
Mobile Home Pork Stall 0 to 200 Amos 0 to 100 Amos
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Tronsformer/Generaior � � INSPECTOR'S USE ONLY
ie Lig. X(mr.
iole Confrol
Pool
$pecial Inspection y r � � ^ —� �
Fneh 1 oore 7
Invesfigafive Fee X" /�C �c ` j (— �' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFPICE USE ONLY This request void I B momhs hom wlidation dale prinRd in ihls box.
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Reqoesl Date RougMin inspenion mquired2 ❑ Yes ❑ No Inspenion Oiher Thon Rougbin: ❑ Reody Now � WIII Call
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I, ❑ licensed contracror ❑ owner hereby request inspection of the obove electrical work ai:
Job Address IStreN, Boz, or Roule No.� Cly Zlp Cade
5�9 ?c,okso.� 5% t=�,vi�r SS�f3Z
Section No. Tovmship Name or No. Ronge No. Fire No- oonry
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Connacro��Compony
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ON BACK OF VELLOW COPV