P - 80748� REQUEST FOR ELECTRICAL INSPECTION
�J J V- 8 5 3 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 Addn
ommercial Industrial Farm Remod Re oir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. O}her:
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 cop�niy.
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Calculate Inspection Fee - This Inspection Request will not be a cepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home 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
Sign/Outline Ltg. Xfmr. ��.5�
Alarm/Remote Contro4
Swimming Pool
I hereb certi that I ins the eleclrical installation described herein on fhe dates sMted
Irrigation B Ro�gMn Dare
Special insp , i
Investigative Fee F��� 4 � ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This requesf void 18 monfhs from validation dafe printed in this box.
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* 0 8 3 8 8 5 3 0* ad"�
PLEASE PRfNT OR TYPE
Request Dafe O, �� Rou h-in ins on r uired$ ❑ Yes .
g pecti eq ❑ No Inspeclion Other Than Rough-In: eady Now 0 Will Call
(You must call the inspector when ready� Dale Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job dress �Str t, Box, or Route N.) � A,✓ Cdy� 4 Z� ode ��
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Section No. Township Name or No. Range No. Fire No. County
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Occupanf Phone No.
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Power Suppliet � ^ A ess
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Electrical Conhatlor (Company Name) Contracfor License No. Masfer Lic. No. (Planf Elecf. Only)
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�,�, � � �t�t;�'i�`►�:Si�; � � .
2�19 Coon Ra i t� �
Auth ' sg � c�Parfer ' g Insfalla n) Phorre No.
v i� �7
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EB-0000 -11 8J96 STA RD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY