P - 813407���J75 �
REQUEST FOR ELECTRICAL INSPECTION '°"IT�
Minnesota State Board of Electriciry �
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 64&0800 .+k+:w-"'�
Water Hh. Load Mgmt Other: "
Elec. Heaf Temp. Service
requesG Enler remarks in fhis spoce and on �he back of the
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Calculofe Inspeclion Fee - This Inspeclion Requesl will nof be accepfed wifhout fhe rorrecf fee:
Other Fee # Service Entrance Size Fee 8 Ci�wifa
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 A
INSPECTOR'S USE ONLV
Sign/Outline Ltg. Xfmr.
Alorm/Remote Control
copy
ihe elecidml tnxmllmlo� deudbed he�el� o� the dote: s�ated
Fee
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$pecial Inspec n F�r�l � �e
InvesHgafive Fee ' - — dL'
THIS INSTALLATION MAY BE ORDEREO DISCONNECTED IF NOT COAIPLETED WITHIN 78 MONTHS.
II� IIIII IIIII II III II III I� I�IIIII �I� IIIII OFFICE USE ONLY This requesl wid 18 mon: mlidotion dme printed �n ihix boz.
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� PLEASE PRINT OR TVPE
Reques �e �� Roughin Inspenion required2 Ves ❑ No Inspecfion Othar Thon Raugh�ln: ❑ Ready Now � WII Call
1� lYo� m�n call ihe insp�m, when r�dy� paa R�dy
I, licensed coNmcior ❑ owner hereby request inspection of ihe above electricol work at
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