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P - 81408, �'07-783 � Home �rr� Calculote Inspecfion Fee - ihis Insp Other F Mabile Home Park Stall Sfreef liq./Tmffic Siq. � � g. X�lilf. Con1f0� REQUEST FOR ELEGTRICAL INSPECTION �" Minnesota State Board of Electricity 1821 Universiry Ave., Rm. S-128, St. Paui, MN 55704 Phone (612) 642-OB00 =��� ,�i quesG Enier remorks in fhis space and on the back of fhe whife copy only. %��'661•� �Lii' �l'l„ �/� S� ��� �� �..c� xtion Reqoesf will not be occepled wi�houf the correct fee: ee # Service Entrance ' fee # Circuits/Feeders Fee f0 0 AinPS - 0 fo 100 Amps %/ �� � Above 200� � INSPECTOp'S USE ONLY herel� on the da�ex xmt�d % Invesfigative Fee - THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MOI3THS. II� I II IIIII I�II II I� �I II� II I�I I II IIIII OFFlCE USE ONLV This reqoesrwid I�ihs hom validation da�e piinte�his box. `NI * 0 6 0 7 7 8 3 8* �7�j PLEASE PRINT OR TYPE Req�es� �ole Roog6ln inspectian reqvired? ❑ No Inspecibn Oiher ihon Rooghlm ❑ Ready Now ill Coll � �Yau musr call rhe �nspecior when ready� Doh Reody: i, ,�Jicensed contracbr ❑ owner hereby request inspection of fhe above elechical work a1: Job Address IStree�, 8ox, or Rou�e No.) .� Ciry _ Zip Code , � Occupam � Pho�re No. Vi SEE INSTNUCTIONS ON BACK OF YELLOW COPY