P - 82749�-5�=340
Home Duplex
Commerc ia l I ndustrial
Air Cond. Htg. Equ
Dryer Range
"X" above the work covered 6
RE(�UEST FOR ELECTRICAL INSPECTION �� ��..
Minnesota State Board of Electricity
1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
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Phone (612) 642-0800
A t. Bld Other: / New Addn
Farm 9 ��j ���� � emod Re ir
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps 7s
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA-�L � /�
$ign/Oudine Ltg. Xfmr. 3 /✓ i �v
Alarm/Remote Confrol
Swimming Pool
I her certi that I i�s the electrica installation described herein on the dates staled
Irrigation Boom RougMn �e �
Special Inspection �� 2 ^
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Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from wlidation date printed in this box.
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* O S 6 5 3 4 O%�R PLEASE PRINT OR TYPE
Requesf Rough-in inspecAon required2 ❑ Yes ��1Vo� Inspecfion Ofher Than Rough�ln: ❑ Ready Now�ill Call
3 (You musf call the inspecfor when ready) J Dafe Ready:
I, icensed contractor ❑ owner hereby request inspection of the obove electrical work at:
Job Addreu (Sheet, Box, or Roufe No.)� Cily � Zip Code
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Secfion o. ownship Name or o. Ranae No. Fire No_ Cn
occopoor
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Power SuR
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Addre
y
ny Name) �
S� �.�s �
w Owner erfa mg Installotion
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cnror or Perfw ng I � Ilafion)
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STATE BQARD COPY - SE!
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Phone No.
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Conhacfor License No. Master Lic. No. (Plant Elecf
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Phone No.
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�ONS ON BACK OF YELLOW COPY