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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MAt 55104 „
Phone (612j 642-0800 ��r
Other: New Addn
Form
Water Htr. locd Mgmt. Other:
Elec. Heat Temp. Service
request. Ente� remarks in this space anc
on
Remod
copy
Cakulate Inspection Fee - This Inspection Reqvest will no► be accepted wifhout the correct fee:
Other fee # Service EMrance Size fee #
Mobile Home Park Stal) Circuits/Feeders Fee
0 to 200 Amps 0 t 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s
ove 100 Amps
Transformer/Generofor INSPECTOR�S USE ONLY
Sign/Oudine Ltg. Xfmr. ' T���
Alorm/Remote Conhol •
M �
Swimming Pool ��
Irrigafion Boom I hereb certi thaf I i— the electricaL'nstallaHon described herein on the dales stated
S ciallns Row,�Mn �
Pe pecfion �
Investigative fee F'"°� !
Dare
THIS INSTALLATION MAY BE ORDERED DISCONNECT�D IF NOT COMPlETE� YVITHIN 18 MONTHS �
-L— �
OFFlCE USE ONiY Thiz ._ �$� B rr.cn:. ,.,,,r va ;uafion do�e prinred in this bw.
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* 0 8 Q 2 3 2 b p* � 0?�5{0
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��A�a ew.ariD COPY - SEE iNSTRUCTiON3 ON BqCK OF YELLOW COPY