P - 812685�2-571
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 Universiry Ave., Rm. S-128, SL Paul, MN 55104
Phone (612) fi42-0800
Water Htr. Load Mgmt pther.
Elec. Heal Temp. Service
requesG Enler remo�ks in �his space and on
ICalculate Inspection Fee - This Inspecfion Bequest will no/ be accepfed withou� the correct fee:
Other Fee k Service Enhance Size Fee Il Circuits
Mobile Home Park Stall 0 l0 200 Amps 0 ro 100 A
Street Lip./TraHic Sip. Above 200_Amps Above 100
fOH'S USE ONLY
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copy
Fee
Imes}igative Fee ' � — --�_
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid I B months 6om wlidmion dote prinred in ihis 6oz.
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I, ❑ licensed conlmcror � owner hereby request inspecfion of the obove electrical work ot:
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Ei«*�mi eo� K �y Na�� _ ontrotla License No. Mvsler Lic. No. �P6m ElecG Only)
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STATE BOAqO COPY - SEE INSfqUCilONS ON BACK OF YELLOW COPY