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Calcu�ote lnspection Fee - This Inspe
Other Fee
Mobile Home Pork Stall
SKee� L�q./TmHic Siq.
requesf.
REQUEST FOR ELECTRICAL INSPEC710N
Minnesota State Board of Electricity
1821 Universiry Ave., Rm. 5-128, St. Paul, MN 55704
Phone (612) 642-0800
. Other �1 � /, S (�� E
.V `JV Re
Load Mgmf. Ofher:
Temp. Service
remarks in fhis spoce and on
m Request wil( not be accepted wifhout the rorrecf fee:
# Service Entrance Size Fee 8, Circuits
f 0 to 200 Amps 0 to 100 A
Above 200_Amps Above lOC
INSPECTOH'S USE ONLV ,��
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I I�:oer_�I �hP Plecnlcal innollmion de.ccribed herein on
copy
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Fee
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Imes}igafive Fee � � / � ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
OFFICE USE ONLY This request vo4d 18 moathv from validolian dare peinted In 16is 6ox.
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PLEASE PRINT OR TYPE
Reques� Do�e Rwgh�in inspecfian requiredR Yex ❑ Na Inspx�im O�her Than Roigh{�_ ❑ Rmdy Now Will Call
�/� a� .-Q / �You musr coll the inspec�o- when reody� Dok Reody:
I, ❑ li<ensed conhaclor ❑ owner hereby request inspection of Ihe obove elechicol work al:
lob add�e.. �s�+ e�, a� a4„� nw.� ay z�P coda
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Conkocror License No. Maskr Lia