P - 81895.
�0?_-262 �
Home Duplex
Commercial Industrial
"X" above the work
REQUEST FOF? ELECTRICAL INSPECTIOI
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 551�
Phone(612)642-080
Apt. Bldg. Other: . � �
farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on the back of the white
Calculofe Inspection Fee - This inspection Request wili r,ot be accepted wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/FeedE
Mobile Home Park Stall 0 to 200 Amps l 0 to 100 Amps�e
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100
TransfOrmer/Generator INSPECTOR'S USE ONLY TC
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I herebvi certi(v ihal I insoected the electrical installaKon descri6ed herein on the c
New
copy
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Fee
�.
Investi ative Fee ' ���� �"
THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTH .
OFFICE USE ONLY This request void 18 months from validafion date pri�ted in this box.
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*08022626:� �3�a�
PLEASE PRINT OR TYPE
Requesf Da Rough-in inspeclion required? ❑ Yes No Inspeclion Other Than Rough-In: ❑ Ready Now � Will Call
�d � �You musf call the inspecfor when ready� Date Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
Job Addreu �Sheef, Box, or oute No.) ,� /� City Zip Code
._� v L i V. �► �V' i G�'�° � 5`�'32-
Secfion No. Township Name w�o. Range No. Fire No. County � _
Occupant '� v � V p� .
� � � i L..r �/(� � ✓� OL r1
Power Su pli Address / ,,
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Elechical Conhacfor�pony Name� _ Contracbr
Address �Conhac�q�.�r Owner
one No.
?G3 s7� 8��$�
�� � 11 • .
Master Lic. No. (Planr Elecf. Only)
' I ?G� s�l �'� �'� �
BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY