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P - 80988RE(1l1EST FOR ELECTRICAL INSPECTION —�/1 �°� C, /I Minnesota State Board of Electricity �f �� �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone (612) 642-0800 `' ` X Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Re air �( Air C j� Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by tfiis request. Enter remarks in this space and on the back of fhe whife copy only. S'u��l- 2,3�4- f ►���/C Calculate Inspection Fee - This Inspecfion Request will not be accepted wifhout the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stali 0 to 200 Amps 2 0 to 100 Amps °O Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL Sign/Outline Ltg. Xfmr. ��.s� Alarm/Remote Control ..............� . ..... I he� certi that I ins the eleclrical installation described herein on the dates stated Irrigqtion Bo RougMn Dare Special Ins - f Investigative Fee F�� "z� " �� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months from validafion dafe printed in this box. ii�iiiiiiliNiiiiiiiiiii�iiiii�n�i� � �o-�-� * D 8 4 3 3 5 4 2* (pd d-3 PLEASE PRINT OR TYPE Requesf Dafe Rough-in inspection required? ❑ Yes No Inspecfion Other Than Rough-In: �Ready Now � Will Call ���B�G�C� �You must call the inspector when ready) Date Ready: I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Address �Sheet, Box, or Roure No.) Ciy Zip Code - %� E �Q/ LF Secfion No, Township Name r No. Range No. Fire No. Cou�ly Occvpant Power Supp�ier n Aufhorized E&OOOOIA S� or Owoer Pe � itlor or Own� � STATE BOARD COPY - SEE Phone No. 4/ 57 - 7�89(0 Conhacfor License No. Master Lic. No. � Phone No. � i YELLOW COPY