P - 808506i3-549
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 Universiry Ave., pm. 5-128, St. Paul, MN 55704
Phone (672) 642-0800
Air Cond. Htg. Equip. Water Htr. Load Mgmt Other:
Dryer Ronge Elec. Heat Temp. $enice
X" g6y ve the work covered�y this reques[ En�er remarks in iFiis s ace and on fhe back of the whi/e copy only.
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Calcu o�e Inspec�ion Fee - his lnspecfion Request wil! no� be accepfed without ihe mrrec� fee:
Other Pee # Service Entrance Size Fee # Cirwits/Feeders Fe�
Mobile Home Park Slall 0 10 200 Amps . D fo 700 Amos
line Lig. X(mr.
mofe Confrol
3 Pool
Boom
Above 200_�
INSPECTOR'S USE ONLY
�Jy_��Gpf -
�hai I inscected �he electrical ins�allofian desai6ed herein on the
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Investigafive Fee ' ' — . . -�_.. — 2 '�'�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLE7ED WITFIIN 18 MONTHS.
I� II �I I� II� �I I� �I I� II I�I III �� I�� OFFlCE USE ONLY This requeei void I P months hom validauon do�e prinred in this box.
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PLEASE PRINT OR TYPE
°f �° �/ �/�� RougMin inspection reqoired2 ❑ Yes No Inspecnon Oihe� ihan Rougbin:
� S 7 �YOU musr coll the invpectoe whe� revdy) pote 0.eody:
licensed conhoclor ❑ owner hereby requesl inspection of Ihe above elecfrical work of:
ldress �Sreef, Bon, or Roula No.I Ciy
� STS Fi�P�oo�o w�j' FA/,D�e
i No. iownship Nome w No. Tgan—go. Fire Na. Cnu�
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�b �rY S C�i����
Su�ppjlier (' J Address
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ol Commcror �C«npony Nome� Contmnor License
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� r� 8/96 � OAqp COPY - SEE iNSTBUCTONS ON BAGK
Now � Will Call �
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No.
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Moster Lia No. (Pioni Elxt On
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ELLOW COPY