P - 816171
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REQUEST FOR ELECTRI' �AL WSPECTION
Minnesota State Board of Ele- ricity
1821 University Avenue Suite S-12p ' Saint Paul, Minnesota 55104-2993
(651) 642-0800 w►� ,,�,$lectricity.state.mn.us
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'X" above the work covered by this request Enter r�y�s in this space and on the back of the white copy on/y.
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Calculate
Mobile Home Park Si�p
Street Ltg. / Tral6c 31Q.
Transformer/(isnsrabr
Sign / Ou� LID. Xhr.�
will not be
0 to 200 Amps
Above 200 Amps
INSPECTOR'S USE ONLY
without the correct fee.
Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
— I hereby certify that I inspected the electrical installation described herein on the dates stated:
� �� ' Rough ln Date
Specfal :rt.�.5t.1
nvestiga'uve Fee F�"ei
Dat�� < a�
r' . TF�1S INSTALLATION MAY RF O- � 0l3C NECTED IF NOT COMPLETED WITHIN 18 MONTHS
�_ �. . .- ............... . ..
OFFIC uest void 18 monMs from vali i ., pnnte� box.�
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�L�ASE PRINT OR TYPE
Request Date � Rou h-In ins ection Y
����� ��n� 9 P requlnd? � Y� � Inp�ctlon OIMk Tlrn Rough�lh: ❑ Ready Now � Will Call
You must call the inspector when ready! Date Ready: [��1��; (�(�
I, Q�censed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ City Zip Code:
tl'i �f3Q �1NG .4t�� iVC-: �Ri QLEY ��q��
Section No. Township Name or No. Range No. Fire No. County
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Occu ant Phone No.
I�UCKEtV� C�} GREG t8'12j5'TQ-98'15
Pow�'e��pplier Address
nnP�s aFrcc�.
Electrical Contractor / Campany Name Contractor License No. Master Lic. No. (Piant Elec[ Onty)
fylA�,"f�,r�r, �{ F t"1"{�l C; r(�, , I(UC' . CAC? 1't 432
Mailing Address (Contractor, Company or Owner Performing Installation)
1�7d�i7 L3t�{7('�� Ai�E .�'_,, �AvA��_ t1At�1. �.��,�7R (��s�j�i9�-t70343/(952)$9C}-3�a�'�
Authorize re(Contractor, Company or Owner Pertorming Installation) Phone Number
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EB-00001A-12 5/T999 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY