P - 79628, ,�
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REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm �tL��� • `X..Q•l�?v�T—°°`� Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy
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Calculote Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other f Service Entrance Size Fee # Circuits/Feeders F
Mobile Home Park Stall � 0 Amps 0 to 100 Amps Qjj
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL, /
Sign/Outline Ltg. Xfmr. �/ � �
Alarm/Remote Conhol
$wimming Pool
I hereb certi that I ins cted the elechical installation described herein on ihe dates stated
_ Irrigation Boom Ro„9h-yya ' 3�U,�
Special Inspection Z
Final Da _ �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 monfhs kom validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf pote Rou h-in ins ecfion re uired8 Yes
g p q ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now Will Call
p� (You must call the inspector when ready) Date Ready:
I, ❑ licensed confractor �owner hereby request inspection of the above electricol work at:
Job Address �Sheef, Box, or Ro�fe No. J Cily Zip Code
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Section No. Township ame o�D RaFg� . Fire. No. County
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Occupant ��1 t- Phone No. �)
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il Conhacior'C�6mp�ny Name�� I Conkacfor License No. I Masfer Lic.
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Address IConka�ctor orJa,wner Pvdecmino Installafiuul
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY