P - 83824REQUEST FOR ELECTRICAL INSPECTION
4/� (�� n� � Minnesota State Board of Electricity
�.� Y'�� 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 Reaair
Air Cond. Hig. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by �this requ Enter remarks in this pace a�d on
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of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted w' u e correct fee: 1Q ��
Other Fee # Service Entra Size e # Circuits/Feeders Fee
Mobile Home Park Stali 0-to 0 to 100 Amps
Street Ltg./Traffic Sig. Above 00 ' Amps bove Amps �. .-`�r
Transformer/Generator INSPECTOR'S usE ON�Y TOTAL
Sign/Outline Ltg. Xfmr. �qK ���`-' � � �������j
Alarm/Remote Control /�7Y� �� P'�"�`'�"`�' J C.=✓ � '" ` Z,
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Swimming Pool f
I hereb certi that I ins ected the electrical installafion described herein on the dates slafed
Irrigation Boom Rough-In — �a
Special Inspecti y � �`� ^9
Final �a ` � r7
Investigative Fee I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validafion date printed in fhis box.
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PLEASE PRINT OR TYPE l�Q,�
Re uest Date Rough-in inspecfion required? ��ves ❑ No Inspection Other Thon RougMn: ❑ Ready Now �.Wil) Call
� �(You must call the inspector when ready) Date Ready:
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I, ,�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) � City � Zip Code
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Secfion No. Township Name or No. Range No. Fire No. ounty
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opplier Address �
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I ontracror �Company Name Contractor License
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Address (Contracror or Ow r Perf�g Installation� �
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ed Sign e(Confracfor or Owner r ing Insfallatio �,,,,
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