P - 81485REOUEST FOR ELECTRICAL INSPECTION ¢�e�� EB-00001-08
� � See instructions for completing this form on back of yellow copy. �� •.
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5��087 �'�'`'-'
X" Below Work Covered by This Request �:;��' -'
ew Add Rep. TypeofBuilding AppliancesWired EquipmentWired
r Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
� Other (specity) Contrador's Remarks:
� �S ti�t tQ y �
Compute Inspection Fee Below:
# 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 �,�'�
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in �atB� j
certify that the abo ti S Final p�
been made. :. � � _
OFFICE USE �NLY
This request void 18 months trom
54087 ^ �`� ����
Request Date Fire� No. Rough•In Inpsection iiequired � Inspect�.,., Other Than Rough-In
(VOU must call inspector when ready) � Ready Now ❑ Will Notify InspecMOr
❑ Yes ❑ No Date Ready
I C licensed contractor � owner hereby request inspection of above electrical work at:
Job Address IStreet. Box o� Route No.) City
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Section No. 7ownship Name or No. Range No. Counry �
A,U'a �C �
Occupant(PRINT� Phone No.
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Power Supplier Address
Electr,ic/al Contractor �Company Name) � Contractor's License No.
!t'c�rc /iLIg�,Z'(C.tC �-'ISGV�/SO
Mailing Atltlress (Contrecto� or Owner Making Installation�
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Authonz S�gnature tContractor�Owner Making Installation� - Phone Number
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MINNESOTA ST E BOARD OF ELECTRICITY ���1 THIS INSPECTION REQUEST WILL NOT
Griggs-Mldway Bltlg. — Room 5773 � -� BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul. MN 55404 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.