P - 80915REQt1EST FOR ELECTRICAL INSPEC710N ��'"`�'+��
8 rJ C'� � O� � Minnesota Siate Boarq of Elec�ricity
� v 1821 Universiry Ave., Rm. S-128, Sc Paul, MN 55704
! Phone (612) 642-0800 �?.:�.°•�� .
Home Duplex Apt. Bldg. Other. New Addn
Commercial Indusirial Farm Remod Reoair
�Air Cond. Hfg. Equip. Wafer Htr, Lood Mgmt. Olher:
Dryer Range Elec. Heaf Temp. Service
"X" obove the work covered by this request Enter remarks in fhis space and on the back of �he white copy only.
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Calculore Inspec�ion Fee - T6is Inspection Request will no� be accepfed without lhe mrrect fee:
Other Fee N Service Entrance Size Fre # Cirtuits/Freders Fee
Mobile Home Park Stall to 200 Amps � �'� 0 to 100 Amps �
Sfreel Lfg./Tmffi<Sig. Above 200_Amps Above 700_Amps
Tronsformer/Genera}or MSPECTOp'S USE ONLY TOTAL
C..�/n��d��e Im Yfm. � ��� i 5 V
COOffO�
thm I inscened Iha aleclrimf I�swllafion dascnbed herein on the da�e::�o�ed
InvestigativeFee .�. �L�c..ti, -, .�= ..
THIS INSTALLATION MAY BE ORDERE� DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S.
OFFICE USE ONLY ihis reques�wid 1 B momhs Fom wlidation dme printed In this ba..
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* 0 8 2 6 2❑ 2 4 s ���'�
PLEASE PRINT OR TYPE
Request D � � Rooghin inspectian requiredz ❑ yes Inspection Oiher ihon RoogMn: ❑ Ready N ill Call
� �Vou musfmllihe inspecrorwhen ready) Date Ready:
1, icensed <ontractor Q owner hereby requesi inspection of the above electr'ical work at:
bb Address (Shcel, Bw, or HwiR No.� Gly Zi Cade
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Sedion No. Tawnzhlp Name ar No. Range N¢ Fire No. Covny�
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