P - 81406n RE�UEST FOR ELECTRICAL INSPECTION
5� L- 5 5 0 Minnesota State Board of Electricity
1821 University Ave., Rm. 5-128, St. Paul, MN 55104
� Phone (612) 6�42-0800 � �
�YW
Water Hir. Load Mgmt. Other
Elec. Heat iemp. Service
reqoest Enrer remorks in /his space and on
Calculok Inspecfion Fee - This Inspecfion Requesf will not be acce
01her Fee S Service EMrance Size
Mobile Home Park Slall 0 to 200 Amps
Stree� Ltg./Traffic Sig. Above 200_ Am �.
Twnsformer/Generaror INSPECTOR'S USE ONLY
Sign%Ou - �%ili-� �«%I"��
Alorm�Re t t - E'�`�R�
S�
Swimminq Pool „ , _ , .,, , ,
withoul fhe corcect fee:
Fee # Circuits
0 to 100 A
Above 100
�,cp'
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copy
Fee
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THIS INSTALLATION MAY BE ORUERED DISCON�TED IF NOT COMPLETED WRHIN 18�MONTHS.
OFFICE USE ONLY This requast wid l�nihs hwn wlidation� �� in ihis boc
IIIIIIII,IIIIIII�I�IIIIIIIIYIIIIIIIUIIUII �` ` Jv
* � 5 3 2 5 Jr' � L�K PLEASE PRINT OR TYPE
Req�est Roughln i�upstion raryfredz ❑ Na Inspectim O�Ire. ihon Ro�gM�: ❑ Rmdy Now ill CoA
�Va� musl call �he I�specior when reody� Dote Reody:
I, ❑ licensed confroctor wner hereby request inspecfion of Ihe obove elechical work af:
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