P - 82481REQUEST FOR ELECTRICAL INSPECTION
�(� Minnesota State Board of Electricity �
'J�� - 2 31 � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612)642-0800/ ` '
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Home Dualex Aot. Blda. Other: / 17 � _ New Addn
Commercial Industrial 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 white copy oniy.
Calculate Inspection Fee - This
Other
Mobile Home Park Stall
Street Ltg./Traffic $ig.
Tra nsformer/Generator
Alarm/Remote Control
Request will noi be accepied without the correct fee:
Fee # Servi e ntrance S' Fee # Circuits/Feeders Fee
0 to Amps 0 to l OQ Amps
Above 200 Am s Above 100 Amps
INSPECTOR'S USE ONLY TOT
G/i�k� ���t<sC To � �
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I hereby certifv that I insPecled the elechical installation described herein on the dates stated
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Special Inspection
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Final D
Investigatrve Fee r��--�0
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months 6om validation date printe s k�z'i
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PLEASE PRINT OR TYPE
Requesf Dafe Rougl�in inspeclion required2 ❑ Yes o Inspecfion O�er Than Rou Mn:
g ❑ Reody Now ❑ Will Call
/ Q�� 3 � V (� (You must call the inspector when ready) Date Ready: / Q� Z s �j v
I, ❑ licensed contractor �owner hereby request inspection of the above elecfrical work at:
Job Address (Sheet, x, or Route No� Ciy Zip Code
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Section No. Tow�ship Name w No. Range No. Fire No. County
3 o a �-,vo�-
Occupanf phone No.
�/°irLl S I�OLI�lA�� 7.6 � .s%Z '�37Q
Elechical Confracfor (C y Name) �
/`-� ,
Mailing Addreu �Conhac r�q�wner Perfo
or
Performing
6 liii
Masfer Lic. No. IPI
3'J 7 Z -�3`?O
1 8/96 gTp�gOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY