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P - 81658RE(�UEST FOR ELECTRICAL INSPECTION 6 6 2 ��� � Minnesota State Board of Electriciry 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 ihe work covered by this request. Enter remarks in this space and on the back of the white copy only. ��i%GS�. /�'%�,�/��s'�.✓ l�'(�llt/+�j� ( �t/'a � �DD �'�'e ���/S Calculate Inspection Fee - This Inspection Request will not be accepted 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 Oa$�d Sireet Ltg./TraFFic Sig. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY T �.r Sign/Outline Ltg. Xfmr. �v a Alarm/Remote Conhol Swimming Pool I hereb ceni that I ins ected the elechical installation described herein on fhe dares sfared Irrigation Boom RougMn �� Speciallnsp 'on Final Imestigative - � Z —0 THIS INSTALLATION MAY BE ORDERED DISCONN CTED IF NOT COMPLETED WITHIN 18 MONTHS. — — — - _-,. _ . . _ — ` — _- — — — _ -r' _ --- — OFFICE USE ONLY This roquesf wid 18 months from validafion dafe printed in this box. � �il� �� III �� ��I �� I�I �I ��i �� I�� �I lil � ��� � I�� �# �� • * 0 6 6 2 7 7 2 3� �%D�S� PLE SE PRINT OR TYPE R�esf fe � Rough-in inspecfion required? ❑ Yes o Inspecfion O�er Than RougMn: ❑ Ready N ill Call �` � �� (You must call the inspeclor when ready) Date Reody: I, licensed confractor ❑ owner hereby request inspection of the above electrical work at: Job dress (Sheet, Box, or Route No.) Ci ZiP C°de �o�-� � � �f . '� ��3a Secfion No. Township Nome or No. Range No. Fire No. Cou � Occupant � Phone No. � /�l�a _� �'3r-�71- �i8'�' Power Supplier . Address � �P/S`�' 2 8 � � t �!� c� .� Elec ical ontracror (Company Name) _ Conhacror License No. Master lic. No. (Planf Elec1. Only) Mailing Address (Conhacror or ner PerForming Installation) � ° ! �� �� � �'��� Authorized Si (Conkactor or ner PerFor m I�tallation) Phon No. � . r' �'� l EB-0OOOlA-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY