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P - 84304, ,�42-307 IDAs Home Commercial Air Cond. "X" above the work 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 ,.�', �-�,�'1. � SUP�(t-tb�. �0�8 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. ������I��IOi��l�l������1����i��������������1� .�s-� • * 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 �