P - 82952RE(IUEST FOR ELECTRICAL INSPECTION -
�� G- 5 0 7 Minnesota State Board of Electricity
1821 University Ave., ftm. S-128, St. Paui, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: ., New Addn
Commercial Industrial Farm � '� � "�
t�C. %% ��'�:" ij� !?C`"/�GG ��i Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: �� �
Dryer Range Elec. Heat Temp. Service
"X" obove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Ftome Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S USE ONLY TOTAL c�,
Sign/Outline lig. Xfmr.
30. `'`
Alorm/Remote Conhol
Swimming Pool y cj
I hereb certi that I ins the elechical inslollation described herein on the d� sTa� /—��
Irrigation Boom p�
Special Inspection —z"�`'�
Da � /
Investigative Fee 1Ce�C
THIS INSTALLATION MAY BE ORDENED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
OFFICE USE ONLY This request void 18 months 6om wlidafion date printed i� this box.
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IIIII INNIIIlIIIINIIII�I
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required8 O Yes ❑ No Inspecfion Ofher Than RougMn: ❑ Ready Now Will Coll
(You must call the inspec�or when ready� Date Ready:
I, ❑ licensed conhactor � owner hereby request inspection of the above electrical work at:
Job Addreu �Sheet. Bw�, or RoWe No.� Ciy Zip Code
:� � � � � A�� �_� . �'4 `o� �.S�f 3 �
Secfion No. Township Name w No. Range No. Fire No. nN � � �
IOaupaM
Phone No.
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onhacror �Company Name� I Controclor License No. I Masler lic. No. �Rlant EIeG. O
dress (Conhacfw or Owner Performing Instollation) �
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SignaNre ntracior w Own �rming InsTallation) . � Noj �� �
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8/96 STA7E RD COPY - SEE INSTRUCTIQNS ON BACK OF YELLOW COPY