P - 83424REQUEST FOR ELECTRICAL lNSPECTION
5 3�2 - 5 4 2 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
. Phone(612) 2-0800
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 theyw�ork covered b�j this r uest. En r remark,s/ 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 wi►hout the correct fee: '
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 ro 200 Amps to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator I CTOR' SE ONLY TOTAL �
Sign/Oudine Ltg. Xfmr. ��/�1 � '
Alarm/Remote Conhol
Swimming Pool ,
I here certi that I in the elechical inslallolion dexribed herein on 1he daFes stakd
Irriyation Boom RougMn Dare
$pecial Inspec ' �
Investigative fee F� ��.-Z �
THIS INSTALLATlON MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- OFFICE USE ONLY This requsst void 18 months 6om validafion dafe prin
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* 0 5 3 2 5 4 2 8* PLEASE PRINT OR TYPE
Request Date RougMin inspeclion requi�ed$ Yes ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now ��11 Call
( �...� � (You must call Ihe inspecfor when ready� Date Ready: ��.
I, ❑ licensed conhacror �owner hereby request inspection of the above elech�ical work at:
Job Addreu (Street, Box, Route No Ciy . Zip Code ��
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Section No. Township NameySNo. Ra� . Fire No. County �
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Occupant Phone No.
G�^^OCe � � �% - Z'��'
vowe.suppker ndd
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Eleehicnl Confracror �Company Nome) Conhactor license No. Masler Lic. No. (Mant Elec1. Orll�
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Mailing Address (Conhacfor or Owner Performin Instal 'on) q �.
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Authon ed ' n re �C actor w P Instollation) Phone No.
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E&00001 A- 8/96 S7p7E gOARD COPV - SEE INSTRUCiIONS ON BACK OF YELLOW COPY '