P - 80860814-185 �
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REQUEST FOR ELECTRICAL INSPECTION "'=��
Minnesota State Board of Electriciry �"
1827 University Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-OB00 `^� ��
� by fhis request Enher remarks in this space and on
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Colculate Inspecfion Fee - This Inspection Request will nof 6e accepfed wifhout fhe correcf fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall 0 to 200 Amps 0 to 100 A
Stree} Lfg./TraHic Sig. Above 200—Am s Above 100
Tmnsformer/Genemror INSPECTOWS USE ONLY
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copy
Fee
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, � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �
OFFICE USE ONLV Thk requesl wid 18 monihs hom volidoiion dole printed'm this bo..
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PLEASE PRINT OR TYPE
Req Dore Rougbin inspection requiredz ❑ Yes InspecFOn O�her Than RwgMn: eady Now � Will Call
�� e g �Yw must mll Me inspMOr when reody� Dare Ready.
I, , licensed confroctor ❑ owner hereby requesl inspection of Ihe obove eledrical work at:
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"""'°� "" '`�'° �ATE BOAPD COPY - SEE INSi1iUCilONS ON BACK OF YELIOW COPY