1365 Cliff RdMINNESOTA STATE BOARD OF ELECTF
Gdggs-Midway Bldg.. qoom Sq28
1821 Universiry qve, SL Paul, MN 55106
Ghone (612) 642-0600
THIS INSPECTION REQUEST WILL NOT
BE AGCEPTED BY THE STATE 80ARD
UNL65S PROPER INSPECTION FEE IS
ENCLDSED
G? 7.43? REQUEST FOR ELECTRICAL INSPECTION ry es-ooooi-os
I//q/? ` ? See mstruchons for complellng ihis torm on back of yellow copy
i v
?? "X" Below Work Covered bV Thrs Request ,?.? 7•?
Ne Add Rep. Type of Buildmg Appliances Wired Eqwpment Wired
Home Temporary Service
Dup(ex Heafer Electric Heatmg
Apt Bwldmg E Load Management
Comm./Industnal e Other (Speafy)
Farm AIr
nditioner
3 Olher(spac ify) CoMractor's Pemarks
Compute Mspechon Fee Befow???'?,
# Other Fee # Service Entrance Size Fee # Cvcwts/Feeders Fee
Swimming Pool
Transformers Q
SignS 0 to 200 A 0 to 100 Amps C
/ Above460 qmps Above 100 Amps oD
Inspectar's Uae only
Imgation Booms ?KD Uc I-r
Special Inspection
?
Alarm/Communication THIS INSTALLATION MAV BE RD
ER ISCON
Other Fee L,y,1,S Q,1 e,.
:l,o(? NECTED IF NOT
COMPLETED WITHIN 16 MON
I, the Electncal Inspector, hereby
oertify that the above inspection has R "" oa?e
been made. F? u,
oatC
I
OFFICE USE ONLY
This reques[ voitl 18 monihs from