P - 80870� REQUEST FOR ELECTRICAL INSPECTION �,."°��^�
8��� 0 6 3 � Minnesota State Board of Electriciry �
1821 University Ave., Rm. 5-128, St. Paul, MN 55704 ���
� Phane (612) 642-0800 - .
°X•
Coku(afe Inspection Fee - This Inspi
Other Fee
Mobile Home Park S1aIl
Srreet Lrg./Tmffic Sig.
line Lig. Xfmr.
mofe Control
3 Pool
Boom
Farm
Load Mpmt I Othec
I Elec Hea� � � Temp. Service �
request Enher remarks in fhis space and on llie back of the white copy only.
� ���
chion Request will no� be cepled withouf Ihe <orrecf fee:
q Service Entrance Size Fee # Circuits/Feeders Fee
0 ro 200 Amps 0 ta 100 Amps
Above 200 Amos Above 100_Amps
INSPECTOF'S IISE ONLY
rhm i msoeaed me e�e�o-�co�
_�___. , Fl�al ! _ / bd
Invesfigafive ee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I� II III II III II III � III II I�II III � I� I I�I OFFICE USE ONLY This request void I B month� validmion� nte� kwx.
* 0 8 1 7 0 6 3 1 * C{ -7 7�
PLEASE PRINT OR TYPE
ques� Da�e goagh in inspxiion required2 ❑ Yes ❑ No Inspeclion O�her Than Rmgh�ln: Feady Now � Will Call
q (Voo musi call tha Inspenor when ready� Dare Reody:
icensed contmcior ❑ owner hereby request inspection oF the above electrical work at:
i ddress �Sreei, Box, or Rooro Nol �.� r�. � n ,_ ,-_ , �
1NC.
ds. MN b5433
2�
��o - b�'38'
C i�l��!/�/liLf � %� 7 -.S�d'10
STAiE ARD COPY - SEE INSfpUCTIONS ON BACK OF YELLOW COPY