P - 81306REQUEST FOR ELECTRICAL INSPECTION '�"�
7(+ I�J o A�(] � Minnesota State Boartl of Electricity �-a
�� r� « J 7621 University Ave., Rm. S-128, St. Paul, MN 55104
.. Phone (612) 642-0800 �'�-
Home Duplex Apt. Bldp. Other: New Addn
Wafer Hfr. Load Mgml. Other:
Elec. Heai iemp. Service
requesG Enter remorks in �his space and on fhe back of fhe white copy
l� �-���°�'�r
Calculafe Inspection Fee - This nspechon Request will nof be accep�ed withouf the mrrect fee:
Other Pee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 l0 100 Amps
Sfreef Lig./TmHic Sig. Above 200—Amps Above 100_Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT�#._ �....,
Confrol
Boom
ihm I�nsoecred the electriml Insiollaiion described herein on ihe dates smred
Investigotive Pee • v V ` �--'r -
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 78 MONTHS.
OFFICE USE ONLY ihis reques� void 18 momhs hom wlidotion dme primed In this 6ox.
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* 0 7 6 8 4 3 9 2* ��Q�
PLEASE PRINT OR TYPE
Reyuest DgW��� RougMn inspxtion required? ❑ Yes Na Inspeciion Other Than RaugMln: eady Now 0 WIII Call
3 (Yoo mos� call �he inspMOr when ,eady) Dore Ready
I, �censed confractor ❑ owner hereby request inspection of the above electrical work ot:
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Phone No.
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Conv Lce se No. MosEr Lic. No.
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