P - 8290163�=871 �
Home Duplex
Comme ial Industrial
Air C Htg. Equi
Dryer Range
"X" above the work covered b
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
Phone (612) 642-0800 `���
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request Enter remarks in Ihis space and ort the back of the white copy only.
Calculate Inspection Fee - This Inspection Requesi will noi be accepted without the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator iNSPecrort'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. �30
Alarm/Remote Confrol
Swimming Pool
I hereb certi ihat I ins the elechical i�stallafion described herein on the dafes staied
Irrigation Boom RougMo Dare
Special Inspection
Investigative Fee ��al �rer ,�� ,
THiS INSTALLATION MAY B ORDERED DISCON D IF NOT COMPLETED WITHIN 18 MONTHS.
� �-— --�- �--� �.��. OFFlCE USE ONLY This request void I S months from validation date printed in fhis box.
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* 0 6 3 4 8 7 1 8* 31�,�
PLEASE PRINT OR TYPE
Req�est Date Rou h-in ins fion r uired?
9 P� eq ' ❑ Yes No Inspection Other Than RougMn: Ready Now ❑ Will Cail
�„S pZ-7 � �' (You must call fhe inspector when ready) Dote Ready: 6� 3 O�
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I, � licensed contractor ❑ owner hereby request inspection of the above elecfrical wo�k at:
Job Address (Sheet, Box, or Route No.) ��h, � Z�P ��Q
%��-3� sTXE e�r., c�0 ��t
Section No. Township Name or No. Range No. Fire No. Counry
Occupant
Pot�l c
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i2TS El.�'�� � c
Mailing Address �Conhactor or Owner Performing
&'`'1�0 a.S'7?`� A ✓� �
or
J Z�,,;
� Insfallafion)
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COPY - SEE I
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Phone No.
7 8�6 — 43.�-
Conhactor License No. Master Lic. No.
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ON BACK OF YELLOW COPY