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P - 80953REQUEST FOR ELECTRICAL INSPECTION �� 6 O�� p O C Minnesota State Board of Eleciriciry O U 1821 Universiry Ave., Rm. 5-128, SL Paul, MN 55104 Phone (612) 642-0800 ���» Home D�plex Apt. Bldg. OFher: New Addn Commercial Indusfrial Form Remod Re air Air Cond. Hlg. Equip. Water Hir. Load Mgmt. Other. Dryer Range Elec Heai Temp. Service "X" obove the work covered by �his requesl. Enier remorks in �his spoce and on fhe back of fhe whife copy only. (�6v+nG�v� �l�dy,o �vr��. Calculote (nspecfion Fee - This Inspection Request will not be occepted wifhouf the correc/ fee: Other Fee k Service Entrance Size Pee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Streef Lfg./Tmffic Sig. Above 200_Am s A6ove 700_Amps Tronsformer/Generafor �NSPECTOR'S USE ONLY TOTAL � Poel I I I hereb� �Pni(� iho� I ome nnm ume Invesligativefee �� / ,j—�,-��'- THIS INS7ALLATION MAY BE ORDERED UISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �� ��I�� IIII� �IIII �I III �I� I III III� II� OFFlCE USE ONLY ihis reqoes� wid 18 mont�m volidofion dote p;n�in th�x. * 0 6 0 7 8 0 6 7* �Q�(� PLEASE PH�NT OR TVPE Requexr pore Rough In Inspection rryuiredZ ❑ Yes }�Ip Inspection Oiher TVwn Rovgh-In: „�keady Now � WIII Coll � �You musi call the inspenor whe� ready� Date Ready I„�licensed contmctor ❑ owner hereby request inspection of �he above electrical work at: lob Addrea ISrced, Boz, «Rouie No.� � � Ciry � _♦ Zio �de � No. I Master Lic. .-1d7 I INSTHUCTIONS ON BACK OF YELLOW COPY