P - 81296REQUEST FOR ELECTRICAL INSPECTION ��
'7C Minnesota State Board of Electricity
�.�I���O �.J �� �� 7821 Universiry Ave., Rm. 5-126, St. Paul, MN 55704 ��
• Phone (612) 642-0800 =
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Cal<ulate Inspection Fee - This Inspedion Requesl will nof be accep/ed wifhout Ihe mrrecf iee:
Other Fee # Service En[rance Size Fee # Circuits
� Mobile Home Park Stall 0 ro 200 Amps 0 to 100 A
Sheef �tg./Traffic Sig. Above 200—Amps Above 100
Transformer/Generator INSVECTOfl'S USE ONLY
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Fee
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OFFICE VSE ONLY This request void 1 B months from volidotion dote primed In rhis box.
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PLEASE PRINT OR TVPE
rqoes! �e gougbin inspection required? ❑ Yes Inspecnon Orher Than Rough�ln: ady Now � Will Call
l� �You musi m!1 the impecbr when reo Date Reody:
�censed contmcYOr ❑ owner hereby requesf inspeclion of the above elecfrical work ot
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BOARD COW - SEE INS CTIONS ON BAGK OF YELLOW COPY