P - 808796�2-069 �
REQUEST FOR ELECTRICAL INSPECTION ����
Minnesota State Board of Electricity �;. �
1821 Universiry Ave., Rm. S-728, St. Paul, MN 55104
Phone (612) 642-0800 `�'�
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Air Cond. Htg. Equip. Waler Nlr. Loa ml. Other. �
Dryer Range Elec. HeaY Temp. Service
"X" �ob/ove ihe work cLovered by fhis requesl. Enfer �emarks in fhis space and on !he back of rhe w6ite wpy only.
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Colculofe lnspecfion Fee - This Inspeclion Requesf will nof be accepled withouf the corred fee:
Other Fee # Service Entrance � e Fee # Cirwits/Feeders Fee
Mobile Home Park Stall tp 00 Amps 0 to 100 Amps
Streef lto./TmHic Sict. Above 200_Amps Above 100—Amps _
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INSPECTOR'S USE ONLY
I I�specred �he elacvical Immllafon described hereln on �he dores
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� THIS INSTALWTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This reqoesi void 18 manths from volidarion date printed In Ihis box.
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PLEASE PR�NT OR TVPE
Requas� Doce ,��/Y � RougMn inspecrion requiredx ❑ yax Inspecron oiher Thon Ro�ghln.- Ready Now 0 Will Coll
ZA� IYo� m.�st mll Ilc innpecror when ready� Dde Reody:
I, licensed confmcbr ❑ owner hereby request inspe<tion of the above elechical work ot:
Job Addre.s 15�rew, 6ox, or Rome .� ciry Zp Code
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Setllan No. Township Nome or No. Ranoe Nn R,e � r..�...
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