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P - 83365REQUEST FOR ELECTRICAL INSPECTION � � � � � � � � � Minnesota State Board of Elec4�icity � " 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �; Phone (612) 642-0800 `' ' Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Re air Air Cond. Htg. Equip. Water Htr. load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this request. Fnter remarks in ihis space and on the bock of the white copy only. /U�w !o 0 4��� o�e�2tiead: S�RV�c.P� Rapye f�oo�� l�as���A� 6�,t� L y�rT SwiTc�, h�ovc� �`G-FZ � a�+� f?ec��P�r,(�eCc�lac% Calculate Inspection Fee - This Inspection Requesf will not be accepted without the correcf fee: Other Fee # Service Entran Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 00 Amp .00 0 to 100 Amps .S� a Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps i S^O Transformer/Generotor INSPECTOR'S USE ONLY TO /� Sign/Outline Ltg. Xfmr. 7 ���C7 Alarm/Remote Control $wimming Pool I hereb certi that I ins ected the electrical installation described herein on the dates sfated Irrigation Boom Rough-In Dare Special Inspecti Final � Date �_� . investigative Fee THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This requesf void 18 monfhs from validation daTe printed in fhis box. � fl�� �� �il �� �I� �� ��� �� ��I I��II �� I� �� �� •�° .�' * 0 7 0 4 1 7 7$� ���v PL SE PRINT OR TYPE Request Dafe Rough-in inspection required$ ❑ Yes No Inspection Olher Than RougMn: eady Now ❑ Will Call /�� 3�� 8 (You must call the inspector when ready) Date Ready: /� I, icensed controctor ❑ owner hereby request inspection of the�above elecfrica! work at: Job Address �Sfreef, Box, or Route No.� - � r Zip Code 2 o v T�i S N, �% $ection No. Township Name or No. Ranpe No. Fire No. County Occupant ` n c7�o Power Supplier Address �EI ical Con actor (Company Name) Conhactor Lia s�i �e ec�it?I c � G C o0 Mailing Address Conhacto� or Owner Performing InsTallafion) S�o �Ceh ���l��e lU� ������ S.� Au�rig�ire (Conhactor or OwnjPerforming Insfallafior� � �, 1 _ . rl o �cr Phone No. s �i s��y Master Lic. No. (Planf Elect. Only) a2 �i �a%e / aRt�l�% S`.S� Phone No. _ g��_� a?.5' � STATE BOARD COPY - SE S UCTIONS ON BACK OF YELLOW CUPY