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REOUEST FOR ELECTRICAL INSPECTION ,�a"���h`=��
Minnesota Siate Board of Eleciricity
1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104 ��'�
Phone (672) 642-0800 =`°��
Dryer Range Elec. Heat Temp. Servi<e
"X" obove fhe work covered by Ih�s quest Enler remorks in this spoce ond on /he back of �he whire copy only.
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Ca�(a�lnspectio ee This lnspec�n Request will �oY be accepted wifhoul fhe correcf /ee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Pee
Mobile Home Park Stoll 0 ro 200 Amps 0 So 100 Amps
$freel Lf ./TmHic Sig. Above 200_Am s Above 700_Amps
Tmncfn.m>r/renernror INSPECTOR'SUSEONLV TO�Lr ✓
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH9.
OFFICE USE ONLY This iequeslwid 7 8 momhs hom validotion dme printed in �his 6ox.
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PLEASE PRINT OR TYPE
Req'��/.i Dot'e7 RoogMn inspenion requiredx ❑ Ves No Inspedion Other ihvn Ro�gh{�_ fteady Now Q Will Call
/�Ci3 9� (Yoo mon mll the Inspxror when ready� Dote Raody:
I, licensed confmctor ❑ owner here6y request inspection of the above electrical work o�:
Job Address (Sneei, Baz, or Ro N Ci Zip Code
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- SEE INSTRUCTIONS ON BACK OF VELLOW COPY I