P - 81292'i e
`!,'b%°494 �
REQUEST FOR ELECTRICAL INSPECTION �.`���
Minnesota Siate Board o� EleciricRy
1821 Universiry Ave., Rm. 5-128, St. Paul, MN 55704
Phone (612) 642-OB00 —a
. Other: New Addn
Air Con Hf . Equip. Wafer HK. Load Mgmt. Othec
Dryer Range Elec. Neat Temp. Service
"X" above /he work covered by this requesG Enrer remarks in Ihis space and on fhe back of fbe white copy only.
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Calculafe fnspecfion Fee - This InspeUion Requesf will nol be accep�ed wilhoW fhe rorrecf fee:
Other Fee # Scrvice Ent nce Size Pee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 O— / 0 to 100 Amos b'..�
INSPECTOR'S USE ONLY
on �he dme. stored
Investigolive Fee - � - �jj�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED IT IN 18 MONTHS.
_ _ -_.__._ -.__—_.--__.--
OFFICE USE ONLV This requesr vo�d 18 momhs hom wlidoro� daie pr�med in �h�s 6ox.
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PLEASE PRINT OR TYPE
Reqoe�t Dme Ro�gMn inspecrian requiredR ❑ Yes Na Inspe<�ion O�her Than Rough{�: Reody Now 0 Will Call
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I,'�licensed confractor ❑ owner hereby requeat inspectiort of t6e above ele<tricol work ot.
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