P - 82934„ RE(�UEST FOR ELECTRICAL INSPECTION
�� � o� 7� Minnesota State Board of Electricity
1 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 ” '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
ir C Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders F
Mobile Home Pork Stall 0 to 200 Amps 0 to 100 Amps �
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO�� �
Sign/Outline Ltg. Xfmr. -�
Alarm/Remote Conhol
Swimming Pool
I hereb certi Ihat 1 ins the elechical insfalla6on deuribed herein on ihe dates sfaled
Irrigation Boom RougMn Dare
Special inspecti - � F�nal �
Investigative Fee � � �"
THIS INSTALLATION MAY BE ORDERED DIS NNECTED IF NOT COMPLETED WI HIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation dafe printed in this box.
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LEASE PRINT OR TYPE
Requ sf Date Rough-in inspeMion required? ❑ Yes No Inspection Olher Than R gMn: Ready Now ❑ Will Call .
(You must call the inspector when ready) Dote Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheei, Box, or Route No.� City � Zip Code
? ��d � E � �n s3'Y3�--
$ecFion No. Township Nome or No. Range No. Fire No. Co ly
Occupanf � Phone No.
� � 4 � J`�7eL —' �15�
Power Supplier Address
� Eleclrical Conhactor (Compony Name) Conkactor License No. Master Lic. No. (Manf Elecf. Only)
SPARK �L�CTRIC CAD
Mailing Address (Contractor or Owner Performing Installafion) �
Au oriz $ignafure ( onkacfor or er P ming nsfallafion� � Phone No.
� � � � � �:� 781-6200
EB-OOOOlA-11 8/96 �p� p D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY