P - 81311REQUEST FOR ELECTRICAL INSPECTION
5��] � C'J C Minnesota State Board of Electriciry
, L J � J 1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
Phone (612} 642-0800
/tN5 �� i
Home Duplex Ao1. Bldn. Other. �!/� 1 / I.�fNew I I Addn I
Calculote Inspxtion Fee - This InspE
O[her Fee
Mobile Home Park Slall
$heet Lfg./TruHic Sig.
Transkrmer/Genemror
$ipn/Oufline L�q. Xfmr.
� Elec. Heat � � Temp. Service �
request Enler remarks in this spoce and on
copy
!equest will nof be accepled wifhout Ihe correcl iee:
Service EMrance Size Fee # Circuits/Feeders
0 Io 200 Amps 0 ro 100 Amps
Above 200_Amps Above 100—Am
PECTOP'S USE O�NL7Y� TOTA
/i(r,5'f?��<l LW F`.� /�°'`� /f 9-�cc.r�
61_P���
e6v wnilv tho� I i�soened �he eleckicai insmllaeon dascribed herein on the dores
f32;
invesligafive Fee " �
THIS INSTALLATION MAY BE ORpERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY iliis requesf wid 1 B mon�hs Fam wlidvfion da�e pnnred in ]his box.
������ ������ ��� �����I) (������ • ��.�
* � 5 3 2 5 7.5 8* PLEASE PRINT OR TVPE ����
^ e, RougMin inspMion reqonedt ❑ Yes ❑ No Inspec�bn piher 1Fwn RwgMn: ❑ Ready Now 0 Will Coll
� `� / (Yau must mll �he inspec�a when reody� Dok Reody
licensed contmclor wner hereby requesf inspeclion of ihe obove elechical wark ot:
Add ss(5 �8ox, or Rou o.l `�� Ciy -- Zip
%
d
n No. TownshiP Nam¢or No. Ronce Nn Fire No. Co���w .
Address
7�
BI1CK
/�3