P - 81213.
REQUEST FOR ELECTRICAL INSPECTION
U� g,� � � � � � � � Minnesota State Board of Electricity �
V 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55704-2993 ��`
(651) 642-0800 www.electricity.state.mn.us `'�'
"X" above the work covered by this request. Enter remarks in this space and on the back ot the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted ' out fhe correct fee:
Other Installations Fee # Service Enhance Size Fee # Circuifs / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 ro 100 Amps
Sheet Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL r
Sign / Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
_ I hrrnhvi cerfifv fhnf I iamected fhe elecfrical inswllation described herein on fhe dates stated:
Special Inspect3'n ' �"
Final �9�� Za �.,p,
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
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* 0 8 7 7 7 1 4 6 * 7�3 g
PLEASE PRINT OR TYPE
Re9�t�� •�� Rough-in inspecfion required? ❑ Yes ❑ No Inspecfion Ofher Than Rough-In: Ready Now ❑ Will Call
� a3 You must call the inspector when ready Date Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above e►ecfrical work at:
Job Address (Sheef, Box, or Route No.) City Zip Code
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Section No. Township Name or No. Range o. Fire No. Coun � �
Occupant .
��
•al Conhacfor / Company Name
DEPENDABLE ELECT
� @Q�or �j�or��� P�ing
oon Rapids. MN 55433
ized $ignafure (Co , ompany or Owner Perfor
1
COPY
J����(//W�� Phone N� ..
Address
Conhacfor License No.
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Installafion)
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ming nsta ation
SEE INST
C 339
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ON BACK OF YELLOW COPY