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P - 82231U���S-�..�fi � REQUEST FOR ELECTRIGAL INSPECTION �� Minnesota State Board of Electricity a 1827 University Avenue Suite 5-128, Saint Paul, Minnesota 55104-2993 ���: (651) 642-0800 www.electricity.state.mn.us `�� �� ' � (� � -..k_.,, ::�'" f '�. �J� Calculate Inspection Fee - This Inspec►ion Request will nof 4Se accepied wi►hout ihe correct iee: Other Installations Fee # Service Entrance Size Fee # Circuifs / Feeders F . Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps // Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator JNSPECTOR'S USE ONLY TOTA�j� 2VO9!'� `� Sign / Outline Ltg. Xfmr. Alarm/Remote Control Swimming Pool I hereb certi that I ins cted the elechical installation described herein on the dates stated: Irrigation Boom Ro�ah-In Dare Investigative Fee r�oai r � � ya; : J� �� I \ t I� THIS INSTALLATION MAY BE ORDERED DiSC NECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This requesf void 18 monfhs kom validafion date prinfed in this box. IIfNIIIIIII1111111111f0111��llfDil�ll � � D 9 6 5 1 5 6 3* �j � �80t�t7 PLEASE PRINT OR TYPE Request Da � Rough-in inspection required? ❑ Yes No Inspecfion Ofher Than ugh-I : eady Now ❑ Will Call You must call the inspecfor when ready Dafe Ready: Q 1, ' ensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: Jo6 ddress (Sheet, Box,.or Route o.� City • Zip Code b (o l��''' I� �-- Section No. Township Name or No. .. Range No. Fire No. County . �, l� �� Power Supplier Ad� Elechical ntractor / Company Name � ��i� �`��� Mailing dress (Confroctor, Co pany or Owner Performing Ins �l� �G,�h��'� Aufhorized S' na e �Contracfor, panY or Owne erformin • ��V VXG/�/ :B-00001A-12 5/1999 ���--- STATE BOAR� [:OPV Phane No. (',1�Dl�LC�a � Master Lic. No. Phone I�'C {N L V/ �V V I SEE INSTRUCTIONS ON HACK �F VELLOW COPV