P - 80957�532-�-567
above fhe work
Gakulale Inspection Fee - This
Other
Mobile Home Park Stoll
Street 17q./Traffic Sip.
� POOI
Boom
RE�UEST FOR ELECTRICAL INSPECTION `��
Minnesota Siate Board of ElecVicily
1821 University Ave., Rm. 5-128, St. Paul, MN 55104 -
� Phone (612) 642-QBOQ �„
Water Htr. Load Mgmf. Other:
Elec. Heat Temp. $ervice
request Enfer remarks in fhis space and on
will not be accepted withou� the mrrect ke:
e�,�itrance,S'ae Fee # Circuits
]0�/. mo�Z _��' ��� 0 l0 100 A
USE ONLY
0
copy on(y.
Fee
THIS INSTA�LATION MAY BE ORDERED qSCONNECTED IF NOT COMPLETED WRHIN 18 MONfliS.
OFFICE USE ONLY This reqoes� void 18 mmihs Fom wlidation dote primed in fhis 6ox.
I�NINNIIN1lfllli�llliillihlhli� �j��� �'�1g�i
* 0 5 3 2 5 �a 7 5�IC PLEASE PRINT OR TYPE �
Requesf Dale Rough:n inspeniori requireC{ Yes ❑ No Inspecno� OThar Thon RoogMn: ❑ Revdy Now Will Call
�`!ou mun call the inspecbr when ready) Date Ra�dy:
I, ❑ licensed contmctor � owner hereby request inspeclion of the above electrical work al:
bb Address (Sheet, Box, o� 2oule I�b_) Ciy Zip Cade
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Sec�ion No. To�mship Name «Na. Ronge Na Fire No. Coony
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i ON BACK OF YELLOW COPY