P - 83241REQUEST FOR ELECTRICAL INSPECTION -
5�� w��� ° Minnesota State Board of Electricity
1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-080
Home Duplex Apf. Bldg. Other: �`Q � New Addn
Commercial Indushial Farm � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy only.
Calculafe Inspection Fee - This Inspection Request will not be accepted withouf the correct fee:
Other Fee # Service ntrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 2 mps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL�/S�
Sign/Oudine Ltg. Xfinr.
(r
Alarm/Remote Conhol
Swimming Pool
I ceni Ifwt I ins Ihe 'cal installation destribed herein on Ihe daAas slaled
Irrigation Boo Ro„9�„ .
Specia) Ins ` /2l� � 2 � —
Final G�
Investigative Fee " �-- �� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHIN 18 MONTHS.
OFRCE USE ONLY ihis requs�t void 18 months from validation date printed in this box.
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* � 5 3 2 5 2 2 �* p ASE PRINT OR TYPE
� R uest afe _` Rough-in inspeclion required? ❑ Yes No Inspection O�er Than RougMn: ❑ Ready N �II CaA
� �s ! 9�; (You musf call the inspedor when ready� Date Ready:
I, ❑ licensed contracror � owner hereby request inspection oF the above electrical work at:
Job Addreu (Sheet, Box, w Route No.) Ciy Zip Code
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SecKon No. Township Name No. Range No. Fire No. Counly
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Power Supplier � P� w Add /� � q �� �
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onhu�Mor �Company Name) Conhacior L'icense No. Masfer lic. No. (PIaM tleel. Vnly)
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dross (Conhacror or Owner Performing Inslallalion)
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Signa �Co hacior or Own� PerForming Inslol n) Phone �`10•
So�65p �6����$�o�
11 8/96 y�A7E gpppD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY