P - 80950REQUEST FOR ELECTRICAL INSPECTION �"�
6�/ry (][]C Minnesota State Board of Electricity
j U� J J J 1821 University Ave., Rm. S-128. St. PauV, MN 55104
.. Phone (612) 642-0800 °��
ome Duolex Aat Bldct. Other: New Addn
Dryer Range Elec. Heal Temp. Service
"X" obove fhe ork c/overed by this request Enter remorks in this space and on fhe back oi th
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Calculafe Inspecfion Fee - This Inspection Requesf will not be accepfed wilhout rhe correct fee:
Other Fee # Servi e Enhan ize Pee N Circuits
Mobile Home Park Slall 0 l0 00 Amp 0 l0 700 A
Sheet Lta./Troffic Sip. A6ove 200—Amps Above 100
INSPECTOH'S USE ONLY
insmllafion described
cop only.
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Fee
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I Imesfigolive Fee � L �
L THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MOKTHS.
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PLEASE PRINT OR TYPE
Requen Dat �� Roughin m:pedion reqoired2 ❑ Yes No Irepxr.an Other Than Raugh Im Ready Now � WII Call
�Yau m�srcallthe inspecrorwhen ready) Do1e Reody:
I, �] li<ensed conhoclor ❑ owner hereby requesf inspecfion of the above elecfricol work af:
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STATE BOAPO COPY - SEE INSTqUCTIONS ON BACK OF VELLOW COPY