P - 79887REGIUEST FOR ELECTRICAL INSPECTION �
� (`, � � � � � � Minnesota State Board of Electricity ,
�(�•� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone (612) 642-0800 ` '
me Duplex Apt. Bidg. 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. Enter remarks in this space and on the back of the white copy only.
R-��r � �� � 2 � 62 �
Calculate Inspection Fee - This Inspeciion Request will not be accepted withouf fhe 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 Amp Q
Transformer/Generator INSPECTOR'S USE ONLY OTAL / O d
Sign/Outline Ltg. Xfmr. �pc�� °' �g�� �
Alarm/Remote Conhol '
Swimming Pool � �'
I hereb cerfi that I ins ��on desc�ibed n th
ktigation Boom RougMln
Special lnspection � ���'� ��
final �.a „ � �
Investigative Fee ��.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date printed in this box.
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* 0 8 a 2 3 3 5 0* �•�'1�
PLEASE PRINT OR TYPE
Request Dafe Rou frin ins fion r uired$ ❑ Yes ❑ R Now � WiU Call
g pec eq ❑ No Inspection Other Than RougMn: eady
+. ��- Q� �You musf call the inspeclor when ready) Dafe Ready:
I, ❑ licensed contractor �owner hereby request inspection of the above electrical work at:
Job Addreu (Street, Box, or�toute No.� Ciy Zip Code
3` - 7a '°' cv ��[ r' ���3�-
Section No. Township Name or No. Range No. Fire No. Co n1y
Otcupanf ri! �� �
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Power Supplier
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Elechical Conhactor (Canpany Name)
Mailing Address (Conhac r or Owner
3 � — �a w.�
Insfallafion)
Phone No.
763��''?�-�e�s
icense No. Master Lic. No. (Planf EIeM. Onf
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY