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P - 82590: 1 �. .. REQUEST 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: ,.i�lf Commercial Industrial Farm 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 white copy only. - tf ��.�5 Calculate Inspection Fee - This Inspection Request will r,ot be accepted wiihout the correct fee: Other Fee # Service Entrance S" e Fee Circuits/Feeders Fee Mobile Home Park Stall to 00 Amps ' 3 0 to 100 Amps - Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL ,�'Q $ign/Outline Ltg. Xfmr. �� Alarm/Remote Control c� Swimming Pool o� Q`��4- !/ � I hereb certi fhaf I ins ecfed fhe elecfrical insfal }ion described herein on the dateYstate� Irrigation Boom Rough-In D - Special Inspection � Investigative Fee Final �-� � ��� _THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS. OFFICE USE ONLY This requesf void 18 months from validafion date printed in this box. I I��� II III �I III �I III II III II II�I III I �/ �/�' - .'� � I III I IIII I.` 12 * 0 8 0 2 2 0 6 3* ��0�{�� � �F�,�.S�F�INT OR TYPE Requesf Dat Rou h-in ins ection r uired? Yes 9 P eq ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call '�dQ (You musf call the inspector en ready) Date Ready: I, ❑ licensed contractor owner hereby request inspection of ihe above electrical work at: lob Address �Sfreet, Box, or Route No.� City � Zip Code /f�jj `%� U� � /efU�`G S5�{33 Section No. Township Name or No. Range No. Fire No. CounN �v , �i'� �� b� Power Suppli Address �) ��' �ess ��ontracror ner Pert ming Installation U (� �C £ /'`=', Owner /"J��v� �9-� Phone No. � i a - �^`7 i - �89L License No. � Master Lic. STATE BQARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY s's� 3�