P - 80935REQUEST FOR ELECTRICAL INSPECTION
C 9 n� C A 7 � � Minnesota State Board o1 Electriciry
�) J G J 7( 1821 University Ave., Rm. 5-128, St. Paul, MN 55104
- Phone (612) 642•0800
Home � Du lex Apl. Bldg. Ofher: 771 New ddn
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Commercial Industrial Farm � Remod R ir
Air Cond. Htg. Equip. Wafer Hfr. load Mgml, qher:
Dryer Ronge Elec. Heal Temp. $enice
"X" obove the work mvered by fhis request. Enfer remarks in this space and on the bock oF rhe whi�e copy only.
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Colculote Inspection Fee - This InspecM1On Request will not be accepted wifhout the correcf iee:
Other Fee # Service Entrance Size Fee k Circuits/Feeders Fee
Mobile Home Park Stall 0 fo 200 Amps 0 ta 100 Amps
$heef lfg./Traffic $ig. Above 200 Am s Above 100—Amps
Tmnskrmer/Genemtor INSPECTOR'S I1SE ONLY TOTAL„� ��
Sipn/Oudine Lfq. Xfmr. O�
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Dale
Imestigative Fee - —
THIS INSTALLATON MAY BE ORDERED DISCONNECTED IF N07 COMPLETED WIiHIN 18 MON S.
OFFCE USE ONLY This requev void 18 monihs from wlidofion dale prinied in �his box.
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PLEASE PRINT OR TYPE
Requesl Dok RoogMn inspe tion rcquired2 ❑ yes a In
specfion qhe. Thon RoogMm ❑ Ready Naw 0 Will Call
— (1'ao musr mll �he inspec�w when reody� p� p��.:
I, �censed confracror ❑ owner hereby request inspecfion of ihe obove eleclricol work oi:
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