P - 80408j REQUEST FOR ELECTRICAL INSPECTION ��•
� . �Z � � ,� � � � � 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. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on ihe back of the white copy only.
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Calculate Inspection Fee - This Inspection Requesi ill not be accepted without the correct fee:
Other Fee # ntrance Size Fee # Circuits/Feeders Fee
Mobile Home Park tall 200 Amps 0!0 100 Amps 3(�
bove 200 Amps Above 100 Amps v�d
Transfor ONLY ' � s'F���� � TOTAL �
gn tlin ;l�-+�-�! n-�-/o�sa f6 F��' �B3
� n� I t�L,.25 - r,a Z..� t f �
ar emo zS^� G-3°'�s l39 t'd.v7 3-3l -af�
Swimming Po ` �`� S� Zf� po
at I ins ted the elechical i tallation described herein on the�sMted
RougMn Date /���
Special I ection ' ���- � "
Investiga p'- ' f��al . �are �j�
d
THIS INSTALLATI $E dERED DI ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFl USE ONLY This requesf void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in ins � h n ���� ❑ Y No Inspection Other Than RougMn: ❑ Ready Now ❑ Will Call
(You must call t en Date Ready:
I� licensed confractor ❑ owner hereby (�quest inspection of the above electricol work at:
Job Address (Sheet, Box, or Route No.) ;, City Zip Code
�/'� �' � / �`�G �
Sec on No. Towns ip Name or No. • Range No. Fire No. County
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o«����
No.
Address
Name) � Contrador license No. � Master Lic. No.
Owner Perfo�ming InsfallaKon� �'
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