P - 80914?� REQUEST FOR ELECTRICAL INSPECTION
5,�s l� 5 9 5 Minnesofa State Boafd of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
�,,. Phone (612) 642�B 00 ' �:- �
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Elec. Heat Temp. Service
request Enter remarks in fhis space and on rhe bc
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Calculote InspecFion Fee - This Inspec�ion Request will not be accep�ed wifhout fhe mrrxf fee:
Othn Fee # Service Entrance Size Fee # Circu�WFeeders
�Mobile Home Park Stall 0 �0 200 Amps �� 0 ro 100 Amps
Street Lta./Tmffic Sia_ Above 200 Amos T� Above 100_A�
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Fee
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InvesligativeFee -' � iiLP�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED If NOT COMPLETED WffHiN 1 MONTHS.
orr�ce use oN�r m„ �w�,r ro�a i a��*, r.om roi�aaro� aere P,��rea �� m�� �,.
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'* 0 5 3 2 5 9 5 (> >K PLEASE PRINT OR TYPE
Request� Date� �� Raghrn inspectiw reqaired2 ❑ Ves Na Inspection Oiher ihon RougMn: ❑ Ready Now ill Cali
J�You musr call the inspecror when reody) Da�e Ready:
I, D licensed conkactor � owner hereby request inspection of the above electrical work at
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