P - 830445�� —520 �
Home Duplex
Commercial Industri
Air Cond. Htg. Ec
Dryer Range
„X" above the work covered
REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-08 „� '��
� � /� �
Apt. Bldg. Other: - S.� �e New Addn
Farm Remod Re air
Water Hh. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in ►his space and on the back of the white copy only.
Calculaie Inspection Fee - This Inspection Request will noi be accepied without the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feedi
Mobile Home Park Stall 0 to 200 Amps / 0 ro 100 Amps
Sheet Ltg./TrafFic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR�s use oN�r TC
� Pool
Boom
t�af
Fee
�� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITNIN 18 MONTHS.
OFFICE 1lSE ql,Y This �squesi void 1 S irom validalion da�e printed in this box.
I IIII I� ��� II �II �� III �� II� (I III II �II � �II I (III �/ �
.s�s
* � 5 3 2 5 2 ��i * PLEASE PRINT OR TYPE
�9� �/'} � Rough-in inspecTion required� o Inspeciion Ofher Than RougMn: Ready Now � Will Call
'" 6 (You most mll the inspecfor when red Dafe Ready:
I, ❑ licensed contractor�wner hereby request inspection of the above elechical work at:
,bb Address (Street, Box, ure No.) Ciy Zip Code
C�(�( �►��n� �—N� ��i� �� ���32_
Seci�on No� Townsfiip Name or r1o. -- Range No. Fire No. Counly �
�O �I —`
Phone No. u l fq
�Jt � �c. �� -- -1 Li `� 1
Power Supplier Add
S Ls I�o�e`� �cd
Eleclrical Contracfor �Company Name� Contracror License No. Masrer Lic. No. (Plant EI
� Maili�g Addreu �Conh�clor or Owner
i�fal ion) ,�j U 7 Phone
1
COPY - SEE INSTRU �NS ON BACK OF YELLOW COPY