P - 81265REQUEST FOR ELECTRICAL INSPECTION
5��� C i 0 Minnesota State 6oard M Electricity
J 1 1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
, Phone (612) 642-0� „ � �
reques/.
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in H�is space ond on
Calculofe Inspeclion Fee - This (nspection Reques} will not be accepfed withou� fhe wrrecf ke:
O[her Fee N Service Entrance Size Fee # CirCUifs
Mobile Home Pork Stall 0 fo 200 Amps 0 ro 100 A
$heef Lig./TraHic Sig. Above 200—Amps Above 100
TronsFormerfGenemlor tt+sveC7oa'S uSe oN�v
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insmllafion�herein�
New
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Fee
' ' _ _ _ _ _ _ I C���'tv—'�—_ Oa 5' , C7�J
COMPLETED WITH 18 MOMHS.
OFFlGE USE ONLY This reqwsl void I B months 6om wlidation dale prinled in Pois 6oz_
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0 5 3 2 5 7 Q 9�c pLEASE PRINT OR TYPE
Requesl Do�e RaugMn irupanion r'redE
equi �Yes ❑ No Inspection O�n Tlwn RaugMn: ❑ Reody Now �II Call
y/� q no� m�,r <en � ����w wne� ,�d�i oa� R�aY:
I, ❑ licensed conhacfor �owner hereby request inspecfian aF ihe abave elechical work at:
bb Address �Sreep eow or Rwle No.l .-.., z., r_�_
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Ph�one No.
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