P - 80873REQUEST fOR ELECTRICAL INSPECTION ''��.
7 J�- 5 4 9� Minnesota State Board of Electricity �.
� 1821 Univeisity Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800 �
Home Duplex Apt Bldg. Ofher: New Addn
Commercial Induahiol Farm Remod Re ir
Air Cond. Hfg. Equip. Warer Htr. Load Mgmt. Ofher:
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by fhis request Enfer tematks in this space and on the back of tfie white copy only.
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Ca(cula�e inspeclion Fee - 7his /nspecfion Request w"d! nof be
Other Fee N Service Fntrance
0 fo 200 Amps
Above 200_�
INSPECTOR'S USE ONLY
ie Llg. Xfmr.
iofe CoNrol
Pool
wirhouY the correc� iee:
Fee N Grcuits
0to 100A
the electrical in:mllanon
Dale
Fee
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' I THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMP�E7eo wi7mrv ia Munins.
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OFFICE USE ONLY This reqoesf void 18 momhs Fom validanon dale prinred in �his 6ox
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PLEASE PRINT OR TYPE
ReG�ea Rou�hin inspenion reqviredg ❑ yes No Inspeaion O�her ihan Ragh In: ❑ Reody Now ill Coll
�You muai wll the inxpxla when revdy� OWe Reody:
I, licensed conimctor � owner hereby request inspection oi fhe above electrical work ot:
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