P - 84304,
,�42-307 IDAs
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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
Farm Remoc
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Q 0
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
�ign/Outline Lig. Xfmr. /�/�' �G'f�T ���
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted the electrical installafion dexribed herein on fhe dafes stafed
Irri9ation Boom Rough-In Dare
Special Inspectio
Investigative Fee C � F� D 7' ���
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in ihis box.
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* 0 4 4 2 3 0 7 5� �� r ��rO
PLEASE PRINT OR TYPE
Reauest Date Rou h-in ins tion r uired?
_�` g pec eq ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
��' I �You musf call ihe inspector when ready) Dafe Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or RouTe No.� Cily Zip Code
2 8 lo �-#4� �iU � t.� si4 � 1�
Seclion No. Township Name or No. Range No. Fire No. County
I Contractor (Company Name)
Harrison Electric
Address1Conhacror or Owner PerForming Insiall
Phone No.
S7l- I
Contracfor License �vo.
Inc. CA00808
��da 301 olden Valle
or Perfo i ns afion� o
' /Y,�110, `� �.� �� fI :�
MN, 55427
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