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.
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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
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No. I Master Lic.
.-1d7 I
INSTHUCTIONS ON BACK OF YELLOW COPY