P - 81408,
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Calculote Inspecfion Fee - ihis Insp
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Mabile Home Park Stall
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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.
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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
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Pho�re No.
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SEE INSTNUCTIONS ON BACK OF YELLOW COPY