P - 81484REOUEST FOR ELECTRICAL INSPECTION ��`�� EB-00001-08
► See instructions for completing this form on back ol yellow copy. �.'
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H 5 4 0 8 8 `X" Be/ow Work Covered by This Request �'��:;;w� °�
ew Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (SpeciTy)
Farm Air Conditioner
Other (syecify� Contractor's Remarks:
Compute Inspection Fee Below.• �AS �' M!z .0 �i
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 Amps Above 100 Amps
SignS Inspector's Use Only: TOTAL
Irrigation Booms �s'„ ��i
Special Inspection
Alarm/Communi THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee � - COMPLETED WITNIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough•in Da � q
certify that the above inspection has 6
Final ate � �`
been made.
OFFICE USE �NLY
This iequest voitl 18 months from
N 54088 ^ ��� ����
� Request te Fire No. Rough•In Inpsection Required Inspyci�.,,, Other Than� Rough-In
3 � p p (Vou mus II inspector when ready) � Ready Now ❑ Will Notify Inspector
� � �Ves ❑ No Date Ready
I licensed contractor ] owner hereby request inspection of above electrical work at:
Job Address (Street. Box or Route No.) City
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Section No. Township Name or No. Range No. County
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Occupant(PRINT� Phone No.
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Power Supplier Address
Electncal Contractor (Company Name� Contractor's License No.
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Mailing Add�ess iContractor or Owner Making Installation�
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Authoriz ignaWre IContractorvOwner Making Installation� , Phone Number
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MINNESOTA ATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. — Hoom &173 BE ACCEPTED BV THE STATE BOARD
1821 University Ave., St. Paul. MN 55704 UNLESS PROPER INSPECTION FEE IS
Phoae (612) 642-0800 ENCLOSED.