P - 79475�[C REQUEST FOR ELECTRICAL INSPECTION ��`'� ��
U� J J J- 7 2 3� Minnesota State Board ot Electriary � =y
1821 llnversiry Avenue Suite S-02B. Sa nt Paul Minnesota 551042993 �n
' (651) 642-0800 www.electnc�tystate.mn.us �'�'�
"X" above fhe work covered by fhis req
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Calculate Inspection Fee - This
Otherinstallotions Fee # .
Mobile Home Park Sfall
Sneet lht. / Troffic Sip.
l00 (�n� S¢�—Ui,Ee. �,��L
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Outline
, Pooi
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337
Requesf will not be occepfed without ihe correc� fee:
<e Size Fee # Gircuits / Feeders
mps 0 to 100 Amps
Amo� � Above 100—Amps
(p o S—�
_ f c�2—
� � Invesfiqafive Fee � �^ �/L-ti I� -�-d�` C
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLf�EB�WITHIN�TSMONTHS.
___— . ._ . . _ _. __._ —._.�__... _.__—�_ --,_..�
�-- - -� -- � OFFICE USE ONLY iks reqoeslvoid 18 momhs hom validofion dme prin�ed In ihis box.
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PLEASE PRINT OR TYPE
ao�s�,��� ���Pe�ro� ,����.ea? v� ❑ No m,����o� oma, mo� ao�yha�: ❑ a�aY Now 0 w��r coii
, Yo� mun mll ihe inspecror when ready Dote Revdy:
I, L4Ticensed contractor ❑ compony ❑ owner hereby request inspection of the above electrical work at .