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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