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P - 80893,��� 1:1 �� Home REQUEST FOR ELECTRICAL INSPECTION �°'° Minnesota State Board of Electriciry 7821 University Ave., Rm. S-128, St. Paul, MN 55104 �� �� Phone (612) 642-0800 � Other: ew Addn Air Cond. Nf . Equip. Waler Hlr. Load Mgml. Ofher. Dryer Range Elec. Heat Temp. Service "X" above fhe work covered by this requesG Enter remorks in �his space ond on fhe back oi fhe whife copy only. �NSna�...�. N€� 10� f��-�.P t'�D�'na-L �o� LO F' � i�l �-�..� asN ��=�'� Colculate Inspec�ion Fee - ihis Inspection Requesi will not be occepied wiihout the mrrect fee: Other Fee # Servire Enhance Size Fee R Circuits/Feeders Fee Mobile Home Park Stall O io 200 Amps 0 to 100 Amps Q, Sfreet Ltg./Troffi< Sg. f+bove 200—Am s Above 100_Amps Tmnsformer/Generator MSPECTOWS USE ONLV OTAL �_,,,.�- ,._ ��. 30.'`� Boom ihe elxviml Insmllafion described herein on the do �re ' THIS INSTALLAiION MAY BE ORDy4e€D DiSCONNECT£D IF NOT COMPLETED WITHIN 18 MONTHS. � OFFICE USE ONLY This request void 18 monlhs from volidafion date printed in Ifiis 6ox. hi IINN� I�� � �� NN�H��� �� �� •�.� * 0 8 0 1 0 8 � 3� S�Qg PLEASE PRINT OR TYPE Re�e-� Date� —� RougMin Inspectian requiredx� s� No Inspecrion Other Than Rough-In: � Ready Now O Will Gall �Vou must call �he inspMOr when ready� Dare Reody: I, (�'�icensed controclor ❑ owner hereby request inspection of the above electrical work o�: Job Address (Sheel, Bax, or kou�e NoJ Ciy Zip Code 1"1..3 t C� oN Q�q S r Ft'zaa0 � Secfion Na. iownship Name or No. Range No. Fire No. Counry Pa�2.K �A..!a7 �a Qr�aY,o,� � o«opa�r iry Name� Conhaciar Licensa No. Mosrer Lic Na �%om Flec� �.�' C n,,,� � C/+o a 3�, S a� ow�, Pa,�,mm9 m.�oum�o�� �,.Ww.�- a...�e � �.S//S iCO or �r P o �I ' Phone Na. n � 't�� �S �� i � I STATE BOAHD COPY - SEE INSTflUCTIONS ON BACK OF YELLOW COPY