P - 809387�4-836 �
RE�UEST FOR ELECTRICAL INSPECTION �`
Minnesota State Board of Electriciry
7821 UniversiTy Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-OS00 �°••8fl..�
"x" above the work covered by this request Enter remarks in this spa<e ond on the back of tk
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Calcula�e Inspec�ion Fee - ihis lnspecfion Reques� will not be occepled wi�hout tiie mrrecl Fee:
Other Fee # Service En[rence Size Fee # Circui[s
Mobite Home Pork Stoll 0 to 200 Amps 0 �0 100 A
Street Llg./Traffic Sig. Above 200—Am s Above l OC
Tmnsformer/Generafor �NSPECTOR'S USE ONLY
ie Llg. Xfmr.
iote Confrol
Pool
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Fee
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, I THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 18 MONTHS.
OFFICE USE ONIY This request void 18 monlhs from validafion dofe prinfed in Iks bax.
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PLEASE PRINT OR TYPE
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�Yoo mos� calhhe Inspecmr whe ready) Dare Reody: �
I, �icensed contractor ❑ owner hereby request inspection of the obove ele<frical work af:
Job Address �Sheeq Boz, or RW� No.� Cly Code
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EBOppOIA-I1 8/9b STATE BOMO COPY - SEE MSTqUCTiONS ON BACK OF YELLOW COPY