P - 82408REQUEST FOR ELECTRICAL INSPECTION
U � � � � � � � � � Minnesota State Board_of Electricity ����%
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
' (651) 642-0800 www.electricity.state.mn.us "�'
"X" above the work covered by this request. Enter remarks in this space and on the back ot the whf�e
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee
Oiher Installations Fee # Service Enirance Size Fee # Circuifs / Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amp.
Transformer/Generator INSPECTOR'S USE ONLY TOTAJ,
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
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copy only.
Wimmin9 00 _ I herebvi certifv that I inscected the electrical installation described herein on the daMs stated:
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� � Investigative Fee � � l � � GG �-^s� / I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S months from validation dafe printed in fhis box.
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P�EASE PRINT OR TYPE
Request Dat Rough-in inspecfion required$ ❑ Yes No � Inspection Other Than Rough-In: ❑ Ready Now Will Call
DOYou musf call the inspecror when ready Date Recrdy: � �
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Addrezs (Sheel, Box, or Route No.) � City Zip Code
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Secfion o. Township Name or No. anga No. Fire No. Co ty �
Occupant Phone No.
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EB-00001A-12 5/1999
iny or Owner Performing
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ny or �wner Perfo�
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STATE BOARD COPY
License No.
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SEE INSTRUCTIONS ON BACK OF YELLOW COPY