P - 81282REQUEST POR ELECTRICAL INSPECTION ��
7 C�T A C(� Minnesota State Board ot Electncity � �
�) °t V �� 7821 University Ave.; Rm. 5-128, St. Paul, MN 55104 ���•
Phone (612) 642-0800 ���
� Calculo�e
Waier Htr. Lood Mgmt Ofher.
Elec Heat Temp. Service
request Enter remarks in this space and on
� V
i
�n Fee - rhis Inspecfion Reques� will nol be �
r Fee # Service Enhance'.
Pork Stall 0 fo 200 Amps
ffic Sig. Above 200—i
3enemfor INSPECTOR'S USE ONIY
Iq. Xfmr.
without fhe wrrecl Fee:
Fee R Circuits
Otol00A
Above 100
whife copy
on :he do�e: sm�ed
fee
THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This reqoesf void 18 monihs from validmion dafe printed in ihis box.
�ul����lll��ll��ll������1����1����1��1���� • ���
s 0 7 6 8 4 6 0 8* o���%
PLEASE PRINT OR TVPE
. Requey pa���_ Roughin inspeclion requiredd ❑ Yes o Inspxnon Other Thon Rough In� eady Now � Will Coll
yI�ou mosr coll ihe lnspecro� when ready) Da1e Ready
I, �{icensed coMmcFor � owner hereby requesi inspection of the above elechical work at:
Jab�Wress (;v�¢l &q, or FomelJo.Y1 _ Ciro A !1 /I Zin Code
� Occupanl
m
�
_.�
STIITE
C �
�,
INSTHUCTIONS ON
No.