P - 80538REQUEST FOR ELECTRfCAL INSPECTION ��� �,
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V- S V 1- 4 5 8�-� 1821 University Avenue S-1 S nt �Minnesota 551042993 ���
� (651) 642-0800 ww ��tri it .y`s}�te.mn.us ��'�'���
"X" above the work covered by this requesi. Enter remarks in this space and on the
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Calculate Inspection Fee - This Inspection Request will not be
Other Installations Fee # Service Entrance Size Fee
Mobile Home Park Stall 0 to 200 Amps
Street Ltg. / TrafFic Sig. Above 200 Amps �
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr.
Alarm/Remofe Control
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copy only.
�pted without the correct fee:
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
the electrica) instailation
irriganon 000m Rough-In Da�
Special Inspection ��S y r
Final ate
Investigative Fee �o - � � �
THIS IIVSTAL�ATION MAY BE ORDERED DISCONNECTED {F NOT COMPLETED WITFiIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes No I�spection Other Than Rough-In: ❑ Ready Now Will Call
�,. � . You must call the inspector when ready Date Ready:
1, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Roure No.) Zip od
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Company Name
rac}or, Comp y or Owner erformir�
cror, Com an r Owner Perfon
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STATE BOARD COPY
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Li ense No. Master Lic. No.
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY