P - 80885�
53�-592
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
Ptwne (612) 642-
Orher C N�
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ui . Wafer Htr. Laad M mL Other.
Elec. Heot Temp. Senice
by this request. Enier remarks in this spoce ond on
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Cakulafe Inspection Fee - This Inspecfion Request wifl nof be accepted wil{roui fhe correcf fee:
Other Fee 8 Service Entrance Size Fee A Circuits/Feeders Fee
Mobile Home Park S�all 0 to 200 Amps 0 to 7 00 Amps L
Streef Lfg./GaHic Sig. Above 200_Amps Above 100_Amps
Tmnsformer/Genemror INSPECTOH'S USE ONLY TOTAL
Sign/Oulline Ltg. Xfmr. LL �/, �O
AlarmfRemoteControl ��_�a/ °�'� �'� Z-S�e1
Swimmin Pool �o^G'Db ��(�'J-
I herebvi ceniH �har I insoec�ed the eleckical mAallation deuribed herein on �he datex smkd
Investigofive Fee � � �C - � PL
TNIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
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_ _ .. — _ _.._..—_. _.
OFHCE USE ONLY This requeslwid I B months 6om wlidation dore printed in this box.
IIIIIIIIIININ111�111111111�I111{IN�INII "� ��,y
%k � 5 3 C� .5 9 2 3* PLEASE PRINT OR TYPE
Requesl Dure NougMin inspec�ion required? ❑ Yes No Inspecnon Olhe� Thon RougMn: ❑ Reody Now Will Call
-` S " 9� �You muslcallihe Inspeciorwhen reody� Data Reody:
I, ❑ licensed conhactor �owner hereby requesl inspecfion of the above eledri<al work aY.
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