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P - 81508� REQUEST FOR ELECTRICAL INSPECTION 7��� n� O Minnesota State Board of Electricity ; 3 1821 University Ave., Rm. S-128, St. Paul, MN 55104 � Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: w Addn � ommercial Industrial Form emod Re air Air Cond. Htg. Equip. Water Hir. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Se ice "X" above the work covered by this request. Enter remarks i 's spa and back of the whife copy only. � l " VX � �P ��� �� � � � ��� � �� G �culate Ins ection Fee - This Ins eciion Re uest will not be cce ted without the correct fee: P P 9 P Other Fee # Service Entrance ize F # Circuits/Feeders Fe ( Mobile Home Park Stall 0 to 0 Amps 0 to 100 Amps Street Lfg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR�S use oN�v TOTAL� � Sign/Outline Ltg. Xfmr. 'N Alarm/Remote Control Swimming Pool I hereb ceAi fhat I ins ted fhe elechical insfallafion dexribed herein on the dates stated Irrigation Boom Roo9l�lo pare $pecial Inspectio Fina) Investigative Fee � � D�� Z " ^ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This requesf void 18 monfhs from validafion dafe prinfed in this box. 1� II III II III II III II IN I ��� �� II � I� � �' �I � 3� � * 0 7 3 8 3 8 0 5� �3 �3 PLEASE PRINT OR TYPE R u t Dafe Rough-in inspecfion required? ❑ Yes No Inspeclion Olher Than Rough-In: ❑ Ready Now ill Call ✓ �� 9 (You musf call fhe inspecfor when read Date Ready: I�i¢ensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Addr $heef, Box, oL oufe�lE� A_ /� ^�l Cf�y � J Zip Code � /� iC�� s %�, t t OC�4'/ Secfion No. Township Name or No. Range No. Fire No. Couny A�Q ,, ^ l � � `T occo �on /) P ' O +ijJ T / • ' 1'i �V V � '! ��/ � Phone No. � �JD� Power Supplier Address � � ` CS � ! dSFI✓e!_G � EI ' I Conhacto� om ny Name� ^� Conh or li ense No. Masfer Lit. No. (Planf Elecf. Only) C '� �� C 1.c Maili g Addre nhactor or ner Performing Ins� ��� , ^` � ��� � // TVV t % / t Authorized a �Con ctor or Owner Performing Installafion, 2 6 9�� Phone No. _ �3� �� EB-0 1 A- 9 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF ve��ow coav