P - 81324REQUEST FOR ELECTRICAL INSPECTfON "�'""�
'�'] '5��, �'i 8 � Minnesota State Board of Electriciry ����
0 J 1821 Universiry Ave., Rm. S-128, SL Paul, MN 55104 ��.�
Phone (612) 642-0800
� Dryer � Range Elec. Heal Temp. Service
"X" above Ihe work covered by fhis requesl. fnfer remarks in lhis spoce and on the bock of the white <opy only.
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Calculate Inspection Fee - This Inspection Reques/ will no� be accepted wi�hou� Ihe mvec� Fee:
Olher Fee # Service Entrance Size Fee # Circuits{Feeders Fee
Mobile Home Park Siall 0 ro 200 Amps 0 l0 100 Amps
Street Lfg./Tmffic Sig. Above 200_Amps Above 100—Amps
Transkrmer/Genemror INSPECIOR'S USE ONLY TOTA�L�[/ [�-a
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on �he dares slafed
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Invest�gahveYee ' - • ��—� �"
THIS INSTALLATION MAY BE OPDEHED DIS ECTED IF NOT COMPLETED WITHIN 78 MONTHS.
OFFICE USE ONLY This request void 18 momhs from volidanon dore printed in ihls bon.
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PLEASE PRINT QR TYPE
:eques� Dare Rough In Inspenlon requkedP ❑ Ves ❑ No Inspxfion O�her Than Raugh I Reody Now � Will Coll
�You m�si �all Me ;nspecmr.A,en ready) Dare Ready:
, icensed conlmcfor 0 owner hereby requesf inspection of fhe obove electrical work at
o Address �Shee�, Box, m Rovk NoJ Ciy Zip Code
9as- - � Sf
lecno� No. Township Nome or Na. Ronge No. Fire No. Coo� //w�
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I NC.