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Mobile Home Park Stall
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REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricity
1821 Uni��ersity Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re ir
Water Hfr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
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�n Request will not be accep►ed without the correct fee:
# Service Entrance Size Fee # Circuits/Feeders Fee
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100 Amps
tNSPECTOR'S USE ONLY TOTAL ��
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I hereby certify that I inspecled the elecfrical installation dexribed herein on the dates slated
Investigative F F�nal ? po�c—� G� _,
/S
THIS INSTALLATION MAY BE ORDERED DI NECTED IF NOT COMPLETED WITHIN 18 MON HS.
OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
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Request Ro h-in ins tion r uired?
���� ug pec eq ❑ Yes No In<_pection Olher Than RougMn: eady Now ❑ Will Call
(You must call fhe inspeclor when ready) Date Ready:
I, icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
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SecNon No. Township Name or No. Range No. Fire No. County
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Phone No.
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY