P - 80933834�-030 �
,.
Hane Duplex
above �he
Colculote Inspeclion fee - This
O[her
Mobile Home Park Stall
Sfreef Lfp./Tmffic $ig.
ie Ltg. Xfmr.
iofe Conlrol
Pool
REQUEST POR ELECTRICAL INSPECTION '��'
Minnesota State Board of Electricity
1821 Universiy Ave., Rm. 5-128, St. Pa�l, MN 55104
Phone (612) 642-0800 �����'°
ni6e.� New Addn
Farm Reloa
Wafer Hfr. Load Mgm�. Ofher:
Elec. Heat Temp. Service
requesG En/er remorks in �his space and w fhe back of fhe white copy
' L(yY L
ion Request will no� be accepfed withou� /he rorrec/ Fee:
# Service En[rance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Above 200_Amps Above 100_Amps
MISPECT�R'S USE ONIY TQTAL�
�hatl
described hereln on
_ �—�c�
THIS INSTALLATION MAY BE ORDERED DISCONnecreo iF nu i wmr�e i �u m � rnrv w rvivn � n�.
OFFICE USE ONLY Thie reqoeslwid 1 B monlhs hom validation dale printed In ihis 6ox.
{i�iiiiliiiiiiii iiii�iiN�iiiiin im � a�"�°
* 0 8 3 4 0 3 0?* �J��
PLEASE PRINT OR TYPE
� 3/• 9 9 Roogfv� Inspecrio� requly dz ❑ Yes ❑ No Inspecto� O�her Than RmgMn Ready Now � WIII Coll
�1'au mus� wll fhe inspectw when reody� Oo�e Ready:
licensed conhaclor ❑ owner hereby request inspection of the obove eiectrical work ot:
� Ocapont
i aon
Ronge No. I Fre No.
�'72 9
��vv,
BOAflD COPY - SEE
No.
I ¢:� �.
� I�
ON BACK OF VELLOW COPY
�Sa�