P - 81284REQUEST FOR ELECTRICAL INSPECTION ��'°" �
7�(�b[' Minnesota State Board of Electriciry
!,� �J �� 7821 Universiry Ave , Rm 5-128, SL Paul, MN 55104 ��
�. Phone (612) 642-0800
Indusirial
Remod
Dryer Range Elec. Heat Temp. Service
"X" above Fhe work covered by this requesG En/er remarks in Ihis space ond on the back of the white copy only.
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Calculate Inspection Fee - This Inspecfion Request will not be accepfed without �he mrrect Fee:
O[her Fee It Service Enhance Size Fee # Circuits/Feeders Fee
obile Home Pork Sfall 0 to 200 Amps 0 fo 100 Amps
Sheet Llg./Traffic Sig. Above 200 Amps Above 100�Amps
TransformerfGeneraror INSVECTOR'SLSEONLY TOTAL
�._ ir�..i�__ i._ v�__ �L � r i�
iha� I insoeued fie
� Investigative Fee �— ' � ( — ��G^"��
THIS INSTALLATION MAY BE OROERED DISC NECTED IF NOT COMPIETED WITHIN 18 MONTHS.
OFFICE USE ONLY This raquertwid 1 B mom6s 6om validation da�e prinred in fhis box.
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PLEASE PRINT OR TYPE
Requesr Ro�gh in inspxfion �eqoired? ❑ Yes Inspenion O�er Than ftwgh In: ❑ Reody Now III Coll
3(f rl 4 (Yoo mus�callthe inspeciorwhan ready� Da�e Ready:
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I, �licensed contracror ❑ owner hereby requesf inspec}�on of fhe above eleclricol work of:
lob AddrelssJ Sreep Bow or Rou�re N,�o.�/�. - P
�7 3 � �.9°s���iN � ��Lr�,Y r c�ae
ISec�ion No. I iownship Name or No. !/ ' I Range
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or
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Phane No.
��°°° ��-• �°� � STpTE BOMD COPY - SEE INSTFUCTIONS ON BACK OF VELLOW COPY