P - 80989RE(�UEST FOR ELECTRICAL INSPECTION
7��� 9 8 2� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
� r Phone (612) 642-0800 �/ / f l�
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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. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspeciion 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 6 to 100 Amps
Street Lfg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT� S
Sign/Outline Ltg. Xfmr. � a
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins ed ihe elechical installation deuribed herein on the dafis stafed
Irrigation Boom RougMn te �
Special Insp� i ' � —
Final Da �
Investigative ee �--
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from va(idation date prinfed in this box.
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PLEASE PRINT OR TYPE C
Request Date Rough-in inspecfion reqvired$ ❑ Yes o Inspecfion Other Than Rough-In: ❑ Ready Now Will Call
�You must call }he inspector when ready) Date Ready: �
I, �icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Slreet, Box, or �No.) Cify Zip Code
l.c1 !ti . � . �iQ � � t� 5Sy'32
Seclion No. Township Name or No. Ronge No. Fire No. County �
Occupanf t Phone No. �r� .
zqd- 6
Power Supplier dress � �
Elechical Conhacior (Company Name) Conhacror License No. � MasTer Lic. No. (Plant Elecf. Only)
r C d0
Mailing Addreu (Conha r or Owner Performing Installafion) .
,' 1/�lN S s l l �
Authoriz na (Contraclor or r Performi Installation� �►'i �!' � PFane No. . . �
t � 6 _ _ a-8 �
EB-00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY