P - 81294REQUEST FOR ELECTRICAL INSPECTION �"'�'�
7 7 9� � A O C Minnesota State 8oard of Electricity 3
� eJ '�f V 1827 Universiry Ave., Rm. 5-126, St. Pau6 MN 55704
- Phone (612) 642-0800
� W.74
Calcu�0� Inspedion Fee - Th�s lnspe
Other Fee
Mobile Home Park Stall
Sireef Lip.fTra(Gc Sip:
�
Farm Remoc
Woter Hir. Load Mgmt. Other:
Elec. Heat 7emp. Service
requesG Enter rem s" �his spoce and on fhe back of the whiie copy
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:lion Request will not be accepled wi�hou� fhe correcl {ee:
# Servite Entranm Size Fee # Circuits/Feeders
0 fo 200 Amps 0 to 100 Amps
Above 200_Am s Above 100_Amps
INSPECTOR'S USE ONLY TOTAL .
eledrical i�:bllono� descnbed haretn o� the dares sbied
Fee
l�i�:
InvesfigafiveFee • .����. . . �°"7 2? c�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 18 MONTHS.
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s// ' 9/ �YOU musr mll rhe Impxior when reody� Date Reody:
I, icensed coniracbr � owner hereby requesf inspec}ion oF fhe above electrirdl work at:
Job Address �Shee�, Box, or Route No.� ^/ ��� '/� Z�P ��e /
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LE ELECTRIC. 4NQ,
s. MN 55� ��������jt�
License
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