P - 812985 �2-573
Calcufo�e Inspection Fee - This Insp�
Other Fee
Mo6ile Home Park Stall
Street Ltp./TmHic Sia.
�e Ltg. xhnr.
io�e Conlrol
Pool
RE�UEST FOR ELECTRICAL INSPECTION •.
Min�sota State Board of Electricity
1821 University Ave., Rm. 5-728, St. Paul, MN 55104
Phone (612) 642-0800. �'
e,
Elec. Heat Temp. $ervice 7WI�ry1N� 0�QL
requesf. Enter remarks in fhis spare ond on fhe back of ihe whiYe copy c
cfion Requesf wil! no� be accepfed witboW the corretf Fee:
N Service Entrance Size Fee M Circuits/Feeders
0 to 200 Amps O l0 10(
Above 200—Amps Above 1
INSPECTOfl'S USE ONLY
,�{(a {�w.s L,
/G'����br 5 Gv.Gtie��
herebr cenilv tha� I I�saecred �he elxtriml insmllation deunbed he
�he
���
THIS INSTALLAiION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �
OfACE USE ONLV ihis reque4void 78 mwnhs hom wlidation dole primed in �his box.
(II�II�II�IIIIII II�II��I�IIIIIIIIII �� �.�.1
� a7�9
* 0 5 3 2 5 7 3 3* P�EASE PRINT OR TYPE
�9 �� Raryl.�� i�specnon reqairad¢ ❑ Yes ❑ Na Inzpeciion OiMr Tho� RoigMn: ❑ Ready Now ill Call
�� 3^�� (Vnu must wll tha i�spector when reudy) �a�e keady.
I, ❑ licensed contmc�or�owner hereby request inspecfion of fhe above electrical work at
bbAddreu�5heet 8o a Rou No) Ctly ��,�, ZiP�ode���
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We�. Nn T�.w�.hle Nnmw nr Nn Ranae Na Fire No. CwnN _ . w
o«�,w��/C�/'07�G
Power SuPPiier � `�
S
Ph No.
G e�'G/10 ��5�4-2/ i'S
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STATE 80ARU CAPY - SEE lNSTIiUCTONS ON BACK OF YELLOW COPY