P - 80946`�` � - REQUEST FOR ELECTRICAL INSPECTION
5 3 2- 5 6 6 Minnesota State Board of Electriciry
1821 University Ave., Rm. S-1 SL P I, MN 55104
Phone (612) 642-080 e,�
Home Duplex Apt. Bldg. O�her: � New Addn
('..�..�..u.rf,.l I.,duebt..l Fn�... %! � Od.ci a Pe......1 Ron..f.
Dryer Range Elec. Heaf Temp. Service
"X" obove rhe work co�v�e�red by this request. EnMr remarks in this space and on �he back of f{
lyil/�.L� 6'i/��
Ca/culafe Inspeclion Fee - 7iris Inspectian Beques� will no� be accepred withou� �he mrtecl fee:
Other Fee # Servi<e Enhance Size Fee # Circuits
Mobile Hame Park Sfall 0 b 200 Amps L 0 l0 100 A
Sheet Ltg./Tmffic Sig. Above 2D0_Am s Above 100
Transformer/Generofor INSPECTOF'S USE ONLY '
$;gn/Ourline Lfg. Xfmr. 2 7 o a t)
copy
Fee
Irrigation Boom Ro„9M„ oare
Special Inspecfion ����
Finol D
Invesli ative Fee
THIS INSTALWTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFIGE USE ONLY This raqi�e9 void 18 mnnlFia han valida4on data printed i� If�is 6c
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%k 0 5 3 �C 5 6 6 7�K pIEASE PRINT OR TYPE C�
R yues� Do1e R«gMn inspecrion required2 ❑ Yes ❑ No Inspect� Am ❑ Ready Now ill O
(Yau mwf call the inspectar when reody� Dme R .
I, ❑ licensed confrocror owner hereby request inspection of Ihe above electricol work� at
lab Address �Skeet, Bos, a Roub No.� Ciy Zip Code
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or No. I Ronae No_ 1 Fire
7(C�onk�acyro/r� �a Oqwner Perfwming I�smllation�
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STIITE BOApD COPY - SEE NlSTHIICTIONS ON BACK OF YELLOW COPY
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