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P - 82547�0��.%_-J5 � Home Duplex RE(1UEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone(612)642-0800 Commercial Industrial Farm 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 sp ce and on �: yesei New Addn Remod /. D D r✓� . �S'a kr �tia �ack of the white copy only. 28�10 Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Mobile Home Park $tall 0 to 200 Amps 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Amps Above 100 Ai Transformer/Generator INSPECTOR'S USE ONLY TOT Sign/Outline Ltg. Xfmr. �il� c dl-�� fr�t '�'�jr`�t "' Alarm/Remote Control Fee > , �O ri� S'o Swimming Pool I hereb certi that I ins ed the elechical insfallafion described herein on the dates stated Irrigation Boom Rough-I� �°}e Special Inspection pa�e� Final f�,QL Investigative fee � �^2� L THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFlCE USE ONLY This requesf void 18 monihs from validafion dafe prinfed in this box. I I��I I� �I� �� I�) II ��I I� I�� I� II��I �II II �II I I��I�% �.� R 1 2 8110 * 0 8 0 2 2 0 5 S�'` `�`` �� PLEASE OR TYPE Request D/q�fe 1 Rough-in inspection requi�ed? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call //�2/ �O (You must call the inspeclor when ready) Date Ready: V I, ❑ licensed contractor �owner hereby request inspection of the above electrical work at: Job Address (Sfreet, Box, or Route No.�� �� �� C��� ��� Z�P�� � � � � Secfion No. Township Name or No. Range No. Fire No. County /� /� �, 1 7 1 �V l�/ 1 Occupanf Power EB-00001 � Y v - � Name� or Owner Phone No. Conhacior License No. — � ! I — � �lN No. .. �{�.,�,ti„ c���.,�� I s � � - �s� � STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY