P - 81427RE�UEST FOR ELECTRICAL INSPECTtON �,�'
-C.1J r3 _� 4 9 � Minnesota State Board of Electriciry
&J O L 1821 University Ave., Rm. 5-128, SL Paul, MN 55104
Phone (612) 642-0800 m._.
Air Cond. Hlg. Equip. Woter Hfr. Load Mgmi. plhec
Dryer Range Elea Heai Temp. Service
�X o ove the work covered by /his reques/ Enter remorks in �his space ond on Ihe back oi fhe white mpy only.
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Calculofe Inspecfion Fee - This Inspection Requesf wil! nof be occepred witbout fhe correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Pork Stall 0 to 200 Amps� � 0 to 100 Amps
Sfreel Ltg./Tmffi<
Tronsformer/Gen
g. Xfmr.
Control
INSPECTOR'S I/SE ONLY
m s Above 100_Amps
TO L ��
(
the elacnlcal mnallanou dexut6ed 6ere1a on Ae dates sw�ed
I Imesfigative Fee —_.I �. .� �....�. � ��/.Z_.. I�
THIS INSTALLATION MAY BE ORDEREO DISCO TED IF NOT COMPLETED WITHI
� OFFICE USE ONLY Thls requesf void I B months Fam wlidotion
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s 0 6 9 2 9 4 9 3 s
PLEASE PRINT OR TYPE
qoysr ata � Rwgh�in Inspection required? ❑ Yes No Inspacfion O�herThan Rough�ln: ❑f
� I�oo muzr mll �he inspxror when ready Daa Revdy.
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licensed conhotfor ❑ owner hereby request inspection of ihe above elecfrical work at:
o� No.
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-" ----'"' ''-' �� STPTE BOARD COPY - SEE INSTPOCTIONS ON BACK OF
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